Pediatric Utilization Review Physician Advisor

Memorial Healthcare System; Town of Florida (NY); On-site; USD 180,000 - 230,000; Full time

Job summary

Memorial Healthcare System is seeking a physician leader to ensure documentation and utilization are compliant, accurate, and consistent across the hospital system. You will collaborate with UR/HIM, medical staff, and health plans to optimize pre-admission decisions, medical necessity determinations, and transfers.

The role requires a Medical Doctor with Florida licensure, strong critical thinking, and the ability to educate staff on utilization review processes.

Qualifications

• Medical Doctor required with Florida medical license.
• Graduate of a medical school approved by the AMA.
• Experience in Utilization Management preferred.

Responsibilities

• Collaborate with Centralized UR/HIM and medical staff to improve utilization and documentation.
• Make decisions on pre-admission, authorization, medical necessity and services/setting, transfers and continued stay.
• Conduct peer-to-peer discussions with health plans when required.
• Educate medical staff on utilization review and documentation benefits.
• Perform regular chart audits for accuracy of clinical documentation and utilization.
• Ability to work weekends and holidays as needed.

Skills

critical thinking

effective communication

decisive judgement

minimal supervision

Education

Medical Doctor

ME license Florida

OS license Florida

Job description

Memorial Healthcare System is seeking a physician leader to ensure documentation and utilization are compliant, accurate, and consistent across the hospital system. You will collaborate with UR/HIM, medical staff, and health plans to optimize pre-admission decisions, medical necessity determinations, and transfers.

The role requires a Medical Doctor with Florida licensure, strong critical thinking, and the ability to educate staff on utilization review processes.