Utilization Review Specialist (Physician Advisor)

Company: Hackensack Meridian Health
Location: Hackensack
Posted on: February 25, 2021

Job Description:

Hackensack Meridian Health is seeking physician advisors for our Care Management Department at Hackensack University Medical Center in Hackensack, NJ. The Utilization Review Specialist (Physician Advisor) is a key member of the healthcare organizations leadership team and is charged with meeting the organizations goals and objectives for assuring the effective and efficient utilization of health care services.The Utilization Review Specialist (Physician Advisor) provides physician support and leadership to the utilization and resource management areas of care management including mentoring/coaching Utilization Review Coordinators/Care Coordinators, reviewing cases for medical necessity, collaborating with physicians, house staff, hospitalists in determining appropriate inpatient versus outpatient/observation status, and participating in denial and appeal processes. The Utilization Review Specialist (Physician Advisor) will act as a member of the Utilization Review Committee, aid Clinical Documentation Specialists, act as a liaison to EHR/IT systems to support best practice medicine, oversee the function and performance of the observation unit, and proactively educate residents, hospitalists, and attending physicians in preventing denials and determining appropriate levels of care for patients. The Utilization Review Specialist (Physician Advisor) will also identify and address issues related to throughput, efficiency, length of stay, resource utilization, readmission avoidance, quality, safety, and patient satisfaction primarily through the performance of multi-disciplinary rounds.This is an administrative position and the successful candidate will form a collaborative partnership with the hospital administration, the medical staff, and the case management department leadership and staff. This partnership will provide a comprehensive clinical resource management program that includes utilization management, progression of care management, social work services, and complex discharge planning.* Highlights include:* Full-Time Utilization Review Specialist (Physician Advisor)* Robust Benefits and Competitive Compensation Packages* Being part of a truly integrated health care network consistently voted to be a Best Place to Work and Most Wired* Employment at a hospital ranked as #4 in New Jersey by U.S. News and World Report* Proximity to the Jersey coastline, a highly desirable place to live and a region celebrated for its summer season offering a myriad of activities associated with its sand and surf and varied entertainmentQualifications:* Board Certified/Board Eligible and Valid NJ License* Minimum of 3 years of Clinical Practice Experience, Preferably in Primary Care* Previous Utilization Management Experience in Acute Care Setting Preferred* Knowledge of CMS Regulations and Knowledge of Nationally Accepted Guidelines such as MCG and InterQual Preferred* Excellent Communication and Interpersonal Skills* Knowledge of CMS Regulations and Knowledge of Nationally Accepted Guidelines such as MCG and InterQual Preferred* Proficient Computer Skills* Strong Organizational Skills with Ability to Multi-task and Set Priorities.* Ability to effectively communicate with professional peers, department members and all levels of administration.Hackensack University Medical CenterHackensack University Medical Center, a 781-bed nonprofit teaching and research hospital located in Bergen County, is the largest provider of inpatient and outpatient services in the state. Founded in 1888, it was the countys first hospital. It was the first hospital in New Jersey and second in the nation to become a Magnet-recognized hospital for nursing excellence; receiving its sixth consecutive designation in 2019Hackensack Meridian Health is seeking physician advisors for our Care Management Department at Hackensack Uni...

Keywords: Hackensack Meridian Health, Hackensack , Utilization Review Specialist (Physician Advisor), Healthcare , Hackensack, New Jersey