14421BR

Title:

Physician

Department/Cost Center:

776 - Quality Assurance

Job Description:

The Utilization Management Physician Advisor is responsible for assisting Highland Hospital’s goals and objectives for assuring the effective, efficient utilization of health care services. The Physician Advisor is a physician serving the hospital through teaching, consulting, and advising the utilization management department. The Physician Advisor shall develop expertise on matters regarding physician practice patterns, over and under-utilization of resources, medical necessity, levels of care, care progression, denial management, compliance with governmental and private payer regulations, appropriate physician coding and documentation requirements.

• Perform secondary level of care reviews.

• The Utilization Management RN will refer cases to the UM PA for review of inpatient, observation or alternative level of care (ALC) criteria.

• Generally for .1 FTE this equates to 8 weeks and 8 weekends per year.

• The Physician Advisor may also be called to complete peer to peer discussions with the payor medical director if the attending of record is unavailable.

• Participate in claims denial process and complete appeals as requested by the denial team.

• This should average to about 3-4 cases per month.

• Appeals may be related to medical necessity or clinical validation.

• The physician advisor may also be called upon to screen cases for appeal.

Salary Range:

$70.00 - $192.00 an hour

The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job’s compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.

Auto req ID:

14421BR

Job Requirements:

Medical License

5+ years of experience

Employment Status:

Part-Time

Hours/Week:

4

Posting Title:

Physician - Dept. of Medicine Physician Advisor Program

City:

Rochester

Work Shift:

Days

Area of Interest:

Clinical Non-Nursing

The Hospital is committed to equal opportunity for all persons regardless of age, color, disability, ethnicity, marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status protected by law.