Utilization Review Specialist (Physician Advisor)
Company: Hackensack Meridian Health
Location: Hackensack
Posted on: February 25, 2021
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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
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