Seeking a Physician Advisor/Medical Director Utilization Review for a Level II Trauma Center and well established hospital serving 255 beds and averaging 15000+ inpatient visits yearly.
Position located 70 miles from Seattle, WA - mild summers, golfer's mecca, stunning waterfalls, clean air, awesome hiking trails, freshwater lakes, coves and tidelands spread out across Larrabee's 2,600 acres.
If you are a physician licensed in the State of WA and is passionate about QI, this will be an ideal opportunity to consider. Relocation assistance available.
Reporting to the CMO, the ideal candidate will support care management and oversee the Utilization Management function for the hospital system.
- conducts clinical reviews on cases referred by care management staff to meet regulatory requirements and in accordance with the hospitals’ objectives for assuring quality patient care and effective, efficient utilization of health care services.
- meets with care management and health care team members to discuss selected cases and make recommendations for care, interacting with medical staff members and medical directors of third-party payers to discuss the needs of patients and alternative levels of care.
- acts as consultant to and resource for attending physicians regarding their decisions relative to appropriateness of hospitalization, continued stay, and use of resources.
- Co-Chairs Utilization Management Committee.
- Serve as second level reviewer for UM, providing guidance on appropriate/alternative levels of care based on InterQual guidelines and other appropriate criteria.
- Function as consultant to and resource for attending physicians regarding their decisions relative to appropriateness of hospitalization, continued stay, and use of resources. Provide education to physicians and other clinicians related to regulatory requirements, appropriate utilization, alternative levels of care, community resources, and end of life care.
- Acts as a liaison with payers to facilitate approvals and prevent denials or carved out days when appropriate. Facilitates, mentors, and educates other physicians regarding payer requirements.
- Support Clinical Documentation Integrity (CDI) with education to attending physicians about ICD coding guidelines, co-morbid conditions and clinical terminology to improve their understanding of severity, acuity, risk of mortality and DRG assignments.
Role has no direct reports. Will exercise influence in Change Management.
Board Certified Physician
Prior experience in Utilization Management or Utilization Review required
Familiarity with InterQual required
Must have experience and success in leading and facilitating groups of physicians.
Licensure as a Physician in WA state is required.
2-Years utilization management experience required.