Pediatric Physician Advisor - Centralized Utilization Review - FT - Days - MHS

Memorial Healthcare; United States; On-site; USD 180,000 - 240,000; Full time

Job summary

Memorial Healthcare System is seeking a physician responsible for utilization review to ensure documentation, data capture, and utilization opportunities are compliant, accurate and consistent.

You will collaborate with the Medical Director of Centralized UR/HIM, utilization committees and medical staff to improve utilization and documentation; decide on pre-admission, medical necessity, services/setting, transfers and continued stay; perform chart audits and educate staff on UR benefits.

Qualifications

• Medical Doctor required and licensed in Florida.
• Active Florida Medical License or Florida Osteopathic Physician License required or pending.
• Experience in Utilization Management or hospital system preferred.

Responsibilities

• Collaborate with the Medical Director of Centralized UR/HIM to enhance utilization and documentation.
• Make decisions on pre-admission, authorization, medical necessity, services/setting, transfers and continued stay.
• Conduct peer-to-peer discussions with health plans when required and serve as UR resource to medical staff.
• Educate medical staff on utilization review processes and documentation standards.
• Perform regular concurrent and retrospective chart audits to assess documentation accuracy.
• May require weekend and holiday work as needed.

Skills

Utilization Review

Clinical Documentation

Communication

Decision Making

Education

Medical Doctor

Florida Medical License

Osteopathic Physician License (FL)

Job description

Location:

Fort Lauderdale, Florida

Summary:

Ensures documentation, data capture and opportunities for utilization are compliant, accurate and consistent.

Responsibilities:

Works in collaboration with the Medical Director of Centralized UR/HIM, utilization committees and medical staff to maintain and improve utilization and documentation efforts.Makes decisions on referred individual patient cases regarding: Pre-admission, authorization, Medical necessity and services/setting, transfers, appropriateness of admission, and continued stay. Conducts peer to peer discussions with health plans when required.Serves as a resource to the medical staff for Utilization Review activities. Educates and communicates to the Medical staff the benefits/need for utilization review and documentation.Performs regular, follow-up and focused chart audits/reviews (concurrent and retrospective) for the purpose of assessing the accuracy of clinical documentation and utilization. Ability to work weekends and holidays as needed.

Education and Certification Requirements:

Medical Doctor (Required)Medical Doctor License (ME LICENSE) - State of Florida (FL), Osteopathic Physician License (OS LICENSE) - State of Florida (FL)

Additional Job Information:

Complexity of Work: Requires critical thinking skills, effective communication, decisive judgment and the ability to work with minimal supervision. The incumbent must be able to work in a stressful environment and take appropriate action when required. Required Work Experience: Minimum of 1 year of work experience in a clinical setting Other Information: Prior experience in Utilization Management with hospital system or health system preferredAdditional Education Info: Graduate of a medical school approved by the Council on Medical Education of the American Medical Association.

Working Conditions and Physical Requirements:

• Bending and Stooping = 60%
• Climbing = 40%
• Keyboard Entry = 100%
• Kneeling = 40%
• Lifting/Carrying Patients 35 Pounds or Greater = 0%
• Lifting or Carrying 0 - 25 lbs Non-Patient = 60%
• Lifting or Carrying 2501 lbs - 75 lbs Non-Patient = 0%
• Lifting or Carrying > 75 lbs Non-Patient = 0%
• Pushing or Pulling 0 - 25 lbs Non-Patient = 60%
• Pushing or Pulling 26 - 75 lbs Non-Patient = 0%
• Pushing or Pulling > 75 lbs Non-Patient = 0%
• Reaching = 60%
• Repetitive Movement Foot/Leg = 40%
• Repetitive Movement Hand/Arm = 100%
• Running = 0%
• Sitting = 100%
• Squatting = 80%
• Standing = 80%
• Walking = 80%
• Audible Speech = 100%
• Hearing Acuity = 100%
• Smelling Acuity = 0%
• Taste Discrimination = 0%
• Depth Perception = 60%
• Distinguish Color = 60%
• Seeing - Far = 60%
• Seeing - Near = 60%
• Bio hazardous Waste = 40%
• Biological Hazards - Respiratory = 0%
• Biological Hazards - Skin or Ingestion = 0%
• Blood and/or Bodily Fluids = 40%
• Communicable Diseases and/or Pathogens = 0%
• Asbestos = 0%
• Cytotoxic Chemicals = 0%
• Dust = 0%
• Gas/Vapors/Fumes = 0%
• Hazardous Chemicals = 0%
• Hazardous Medication = 0%
• Latex = 0%
• Computer Monitor = 80%
• Domestic Animals = 40%
• Extreme Heat/Cold = 40%
• Fire Risk = 0%
• Hazardous Noise = 0%
• Heating Devices = 0%
• Hypoxia = 0%
• Laser/High Intensity Lights = 0%
• Magnetic Fields = 0%
• Moving Mechanical Parts = 0%
• Needles/Sharp Objects = 0%
• Potential Electric Shock = 0%
• Potential for Physical Assault = 40%
• Radiation = 0%
• Sudden Decompression During Flights = 0%
• Unprotected Heights = 0%
• Wet or Slippery Surfaces = 0%

Shift:

Primarily for office workers - not eligible for shift differential

Disclaimer:

This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification.

Wages shown on independent job boards reflect market averages, not specific to any employer. We encourage candidates to talk to their Memorial Healthcare System recruiter to discuss actual pay rates, during the hiring process.

Memorial Healthcare System is proud to be an equal opportunity employer committed to workplace diversity.

Memorial Healthcare System recruits, hires and promotes qualified candidates for employment opportunities without regard to race, color, age, religion, gender, sexual orientation, national origin, veteran status, disability, genetic information, or any factor prohibited by law.

We are proud to offer Veteran’s Preference to former military, reservists and military spouses (including widows and widowers). You must indicate your status on your application to take advantage of this program.

Employment is subject to post offer, pre-placement assessment, including drug testing.

If you need reasonable accommodation during the application process, please call 954-276-8340 (M-F, 8am-5pm) or email [e-mail]