Clinical Utilization Specialist

1 month ago


Dayton, Ohio, United States Premier Health Partners Full time
Job Summary

The Physician Advisor plays a critical role in ensuring high-quality, safe patient care by conducting clinical reviews and collaborating with healthcare professionals to optimize resource utilization. As a key member of the Premier Health Partners team, this individual will work closely with physicians, nurses, and other stakeholders to promote effective and efficient care delivery.

Key Responsibilities
  • Conduct thorough clinical reviews of patient cases to ensure compliance with regulatory requirements and hospital objectives.
  • Collaborate with healthcare professionals to identify opportunities for improving patient care and reducing unnecessary utilization.
  • Develop and implement strategies to promote effective clinical documentation and reduce medical record errors.
  • Provide education and training to physicians and other clinicians on regulatory requirements, clinical best practices, and utilization management principles.
  • Participate in daily huddles and utilization management team meetings to stay informed about hospital operations and identify areas for improvement.
Requirements
  • Medical Doctorate degree (MD or DO) from an accredited institution.
  • Current licensure to practice medicine in the state of Ohio.
  • Board Certification in a medical specialty (current or expired).
  • CHCQM Physician Advisor certification.
  • Minimum 5 years of experience in clinical practice, with a focus on utilization management and quality improvement.
Preferred Qualifications
  • Leadership experience in clinical practice, programs, and projects.
  • Strong knowledge of federal, state, and payer regulatory requirements related to healthcare utilization and quality management.


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