Physician Utilization Review Specialist Per Diem HUMC

3 weeks ago


Hackensack, New Jersey, United States Hackensack Meridian Health Full time
Job Summary

We are seeking a highly skilled Physician Utilization Review Specialist to join our team at Hackensack Meridian Health. As a key member of our healthcare team, you will play a critical role in ensuring the integrity of clinical records and promoting high-quality patient care.

Key Responsibilities
  • Regulatory Compliance: Provide guidance and support on CMS and NJDOH regulations governing utilization management and clinical documentation.
  • Liaison and Communication: Serve as a liaison between medical staff and other clinical staff, utilizing excellent communication skills and a broad spectrum of clinical knowledge.
  • Education and Advisory: Provide formal educational lectures, engage in informal meetings, and conduct retrospective medical record documentation reviews.
  • Utilization Review Process: Evaluate patient status based on length of stay, level of care requirements, and Medicare regulations, and conduct reviews of Major Complications or Comorbidities (MCC) / Complications or Comorbidities.
  • Leadership and Staff Management: Develop and implement utilization management strategies, provide guidance and support for executing targeted utilization management strategies, and work with clinical delivery and operations leadership to support medical management effectiveness.
Requirements
  • Education: Medical degree from a recognized medical school and completion of a residency program from an accredited medical institution.
  • Experience: Minimum of 3 years medical practice experience.
  • Licenses and Certifications: Medical Doctor License and at least one Medical Board Certification.
About Us

Hackensack Meridian Health is a leading healthcare organization committed to delivering high-quality patient care and promoting a culture of excellence. We are proud to be a Mandatory Influenza Vaccination Facility and are dedicated to providing a safe and healthy work environment for our employees.



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