Physician - Physician Advisor Utilization Management - Corporate
Core
Physician Advisor supporting Utilization Management to ensure compliance with organizational plans, manage patient status, and facilitate appropriate levels of care.
Role type
Physician Advisor (Utilization Management)
Builds
Utilization Management Plan compliance and patient care pathways
Domain
Healthcare / Utilization Management
Deliverable
client delivery
Required skills
Clinical decision making, regulatory compliance, payer liaison, medical record review, care level assessment, stakeholder collaboration
Preferred skills
CRT-DEA Registration, CRT Physician Advisor Certification, CRT Physician Advisor Sub-Specialty certification, CRT ACMA Physician Advisor Certification
Technologies
Electronic Health Records (EHR), Utilization Management software
Responsibilities
Review patient status upon hospital entry and observation cases, manage concurrent utilization management denials, act as consultant on federal and state utilization regulations, provide feedback to physicians on level of care and length of stay, participate in long stay patient reviews, liaise with payers to facilitate approvals, educate clinicians on regulatory requirements.
Seniority
Individual Contributor