Medical Doctor Utilization Management Specialist
5 days ago
We are seeking a highly skilled Medical Doctor to join our Utilization Management Department as a Physician Advisor. As a key member of our team, you will work collaboratively with utilization management, quality, and clinical teams to ensure that patients receive medically necessary, clinically appropriate, and high-quality care.
Key Responsibilities:- Perform medical necessity reviews and determine clinical appropriateness of care
- Examine resource utilization and conduct reconsiderations with payors' medical directors
- Communicate with clinical teams to ensure accurate documentation and severity of illness
- Act as a resource to clinical, care management, and non-clinical staff, identifying opportunities for process improvement
- Conduct resource utilization reviews to improve healthcare efficiency and costs
- Must hold a New York Medical Doctor License and current registration
- A minimum of 5 years' inpatient acute care clinical experience
- Working knowledge of CMS's two-midnight rule, Medicare coverage criteria, and associated regulatory and payer requirements
- Experience in population health, clinical integration, and cost containment activities, along with managed care experience and utilization management
Why this role matters: As a Physician Advisor, you will play a critical role in ensuring that our patients receive the highest quality care while also helping to improve healthcare efficiency and costs. If you are a motivated and detail-oriented Medical Doctor with a passion for utilization management, we encourage you to apply for this exciting opportunity.
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Physician Advisor for Utilization Management
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