Physician Advisor - Centralized Utilization Review - FT - Days - MHS

Job description

Location: Miramar, Florida At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience. Summary: Ensures documentation, data capture and opportunities for utilization are compliant, accurate and consistent. Responsibilities: Performs regular, follow-up and focused chart audits/reviews (concurrent and retrospective) for the purpose of assessing the accuracy of clinical documentation and utilization. Ability to work weekends and holidays as needed.Makes decisions on referred individual patient cases regarding: Pre-admission, authorization, Medical necessity and services/setting, transfers, appropriateness of admission, and continued stay. Conducts peer to peer discussions with health plans when required.Works in collaboration with the Medical Director of Centralized UR/HIM, utilization committees and medical staff to maintain and improve utilization and documentation efforts.Serves as a resource to the medical staff for Utilization Review activities. Educates and communicates to the M...