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Inpatient Care Specialist
2 months ago
Overview
Catholic Health Initiatives is dedicated to providing compassionate care through a vast network of over 700 healthcare facilities across the United States. Our mission is to serve the needs of our communities, especially those who are most vulnerable. We are committed to innovating healthcare delivery, ensuring that quality care is accessible to all.
Key ResponsibilitiesThis position is remote, with a preference for candidates licensed in Texas. Other state licenses may be considered for future opportunities.
The Utilization Management Physician Advisor plays a critical role in evaluating clinical cases referred by case management and other healthcare professionals. This position ensures compliance with regulatory standards while promoting high-quality patient care and efficient use of healthcare resources. The Physician Advisor collaborates with case management teams and healthcare professionals to review cases, provide recommendations, and engage with medical staff and third-party payers regarding patient care needs and alternative treatment options.
Essential Duties- Conduct thorough reviews of medical records to assess the necessity of inpatient admissions, the need for continued hospital stays, and the adequacy of discharge planning.
- Possess a comprehensive understanding of ICD-9-CM, ICD-10-CM/PCS, MS-DRG, APR-DRG, and the Medicare Inpatient Prospective Payment System (IPPS) to evaluate the severity of illness and communicate effectively with treating physicians.
- Act as a liaison between the national care management team and medical staff to foster cooperation and emphasize the importance of accurate documentation.
- Assist in disseminating information about internal physician advisor services through hospital newsletters and other communication channels to educate medical staff.
- Provide feedback on program outcomes to facility leadership, including Chief Medical Officers and Care Management Directors.
- Deliver educational support to Care Management and Clinical Documentation Departments through effective communication and tracking for process improvement.
- Participate in relevant facility committee meetings, including:
- Clinical Documentation Steering Committee
- Extended Length of Stay Rounds
- Utilization Review Committee
- Care Management Staff Meetings
- Engage with attending physicians through direct communication to introduce referral services and new offerings.
- Facilitate Peer to Peer discussions with payers as necessary, coordinating with operations to support physicians and attending relevant committee meetings.
- MD or DO degree required.
- A minimum of 3 years of experience as a Physician Advisor is essential.
- At least 5 years of clinical practice experience is required.
- Experience with Peer to Peer Reviews is necessary.
- Must hold an unrestricted license in the field of practice in one or more states, with Texas preferred.
- Extensive knowledge of clinical practice and respect from medical staff.
- In-depth understanding of CMS regulations, including the 2-midnight rule.
- Experience in utilization management is essential.
- Continuous education in quality and utilization management is preferred.
- Proficient in business English, spelling, and arithmetic, with strong written and verbal communication skills.
As you contribute to transforming the healthcare landscape, we offer a comprehensive benefits package that includes Medical/Dental/Vision coverage, Flexible Spending Accounts, Life Insurance, Short and Long-term Disability, a 401k match, Paid Time Off, Wellness Programs, Tuition Reimbursement, and more.
#LI-Remote
Compensation$155.69 per hour
