Physician Advisor-Utilization Management

Samaritan Health Services; Corvallis (OR); On-site; USD 200,000 - 260,000; Full time

Job summary

Samaritan Health Services Hospitals seeks an experienced physician to lead utilization management reviews. The role involves medical consultation, admission and discharge decisions, and coordinating with hospital leadership to optimize patient care and length of stay.

Candidates must hold an MD/DO, be board certified, have Oregon licensure, and at least five years of hospital-based adult care experience. Knowledge of EMR systems and medical literature is preferred.

Qualifications

• MD or DO degree required.
• Board Certification required.
• Unrestricted license to practice medicine in the State of Oregon required.
• Strong broad based clinical background with five (5) years of medical experience caring for adult patients in a hospital setting required.
• Three (3) years experience in similar areas of accountability preferred.
• Experience with computer applications, electronic medical records, other medical programs and electronic medical literature required.
• Experience with hospital Utilization Review, Medicare regulations and health insurance policies preferred.
• Experience efficiently researching, analyzing and summarizing complex clinical topics preferred.

Responsibilities

• Provides medical consultation and utilization management case review.
• Acts as a liaison with medical staff and hospital administration regarding admission, discharge, and length of stay and service utilization decisions.

Skills

Medicine

Compliance

Business Writing

Communication

Conflict resolution

Education

MD/DO degree

Board Certification

Oregon Medical License

Tools

EMR systems

Medical literature databases

Job description

Provides medical consultation and utilization management case review at Samaritan Health Services Hospitals. Acts as a liaison with medical staff and hospital administration regarding admission, discharge, and length of stay and service utilization decisions.

DEPARTMENT DESCRIPTION

The Utilization Management team is a centralized team of physicians, nurses and specialists that perform admission and continued stay compliance reviews for all Samaritan Hospitals. Utilization Management nurses and physicians are specially trained in Medicare and commercial insurance regulations, perform reviews on all admitted patients and provide staff and physician education. The Utilization Management team communicates information to insurance companies to assure payment of hospital services.

EXPERIENCE/EDUCATION/QUALIFICATIONS

MD or DO degree required.

Board Certification in the practice specialty required.

Unrestricted license to practice medicine in the State of Oregon required.

Strong broad based clinical background with five (5) years of medical experience caring for adult patients in a hospital setting required.

Three (3) years experience in similar areas of accountability preferred.

Experience with computer applications, electronic medical records, other medical programs and electronic medical literature required.

Experience with hospital Utilization Review, Medicare regulations and health insurance policies preferred.

Experience efficiently researching, analyzing and summarizing complex clinical topics preferred.

KNOWLEDGE/SKILLS/ABILITIES

Medicine - Possess the skills and knowledge needed to review clinical documentation regarding human injuries, diseases, and/or behavioral conditions. Ability to recognize symptoms, understand drug properties and interactions and evaluate the treatment planned or provided by other SHS providers.

Compliance - Ability to evaluate information to determine compliance with laws, regulations, or standards in the clinical and utilization management areas of responsibility. Uses clinical and regulatory knowledge to verify compliant process application.

Business Writing - Strong business writing skills, including the ability to professionally communicate clinical content in written/typed documentation that is easily understood by the end user. Ability to use a computer for required documentation.

Communication - Effective written and oral communication skills to explain complex medical and regulatory issues, exchange information between team members, and tactfully discuss and teach utilization management and compliance concepts. Ability tolisten and understand complex information and ideas.

Conflict resolution - Influences others to build consensus and gain cooperation. Proactively resolves conflicts in a positive and constructive manner.

PHYSICAL DEMANDS

Rarely
(1 - 10% of the time)

Occasionally
(11 - 33% of the time)

Frequently
(34 - 66% of the time)

Continually
(67 – 100% of the time)

CLIMB - STAIRS

LIFT (Floor to Waist: 0"-36") 20 - 40 Lbs

LIFT (Floor to Waist: 0"-36") 40 - 60 Lbs

LIFT (Floor to Waist: 0"-36") 60 or more Lbs

LIFT (Knee to chest: 24"-54") 0 – 20 Lbs

LIFT (Waist to Eye: up to 54") 0 - 20 Lbs

LIFT (Overhead: 54" and above) 0 - 20 Lbs

SQUAT Static (hold >30 sec)

SQUAT Repetitive

REACH - Upward

Enter and Exit Vehicle

STAND

WALK – LEVEL SURFACE

LIFT (Floor to Waist: 0"-36") 0 - 20 Lbs