Join Our Team as a Physician Advisor - Utilization Management
At Erlanger Baroness Hospital, we're committed to delivering exceptional patient care and driving healthcare excellence. We're now seeking an experienced Physician Advisor to join our team in a part-time, remote capacity. As a Physician Advisor - Utilization Management, you'll play a critical role in ensuring compliance with regulatory guidelines, driving quality improvement initiatives, and providing medical leadership to our Utilization Management department.
About Our Organization
Erlanger Baroness Hospital is a leading healthcare provider in Chattanooga, TN, dedicated to delivering high-quality, patient-centered care. Our team is passionate about making a difference in the lives of our patients and the community we serve. As a Physician Advisor, you'll be an integral part of our team, working collaboratively with healthcare professionals to drive positive outcomes and improve patient care.
Key Responsibilities
- Provide medical leadership for the Utilization Management department, assisting in the planning, development, and implementation of program goals and operations.
- Ensure compliance with regulatory agency guidelines, including JCAHO/DNV and other relevant standards.
- Participate in peer-to-peer discussions with managed Medicaid, managed Medicare, and commercial insurance medical directors to drive informed decision-making.
- Offer subject matter expert guidance on utilization management activities, including admission status, medical necessity, and compliance with governmental rules and regulations.
- Collaborate with IT to ensure logical processes, best practices, and compliance with CMS regulations.
- Promote professional development of UM staff, focusing on compliant patient status assignments, consistent use of primary screening criteria, and knowledge of regulatory changes.
- Work with Revenue Integrity to reduce denial and appeal burdens, improving the accuracy of initial patient status determinations.
- Interface with Compliance as a subject matter expert for government regulations and annual audits.
- Assist with the development and implementation of improvement initiatives, providing feedback to medical staff on utilization management determinations.
- Pursue opportunities as a member of strategic committees outside the organization to stay abreast of current trends, regulatory guidance, and national policy.
- Serve as a member of the Utilization Review Committee (URC) and Outlier and Recertification meeting.
- Provide secondary level physician reviews and continuing stay reviews.
- Participate in interdisciplinary rounds (IDR) to advise on clinical resource utilization and throughput.
- Assist with training new UM department hires.
Essential Qualifications
To be considered for this role, you must meet the following minimum requirements:
- A minimum of 5 years of clinical practice in your field of specialty or previous experience as a Physician Advisor.
- M.D. or D.O. degree from an accredited institution.
- Completion of an approved residency and, if applicable, fellowship program.
- Licensure to practice in the State of Tennessee.
- Board Certification in your practice specialty.
- Willingness to obtain CHCQM-Board Certified in Health Care Quality Management and CHCQM-PHYADV subspecialty Board Certification as a Physician Advisor in HCQM.
Preferred Qualifications
While not mandatory, the following qualifications are highly desirable:
- Previous experience in utilization management or a related field.
- Knowledge of regulatory guidelines, including JCAHO/DNV and CMS regulations.
- Strong communication and interpersonal skills.
- Ability to work collaboratively with healthcare professionals and other stakeholders.
Skills and Competencies
To succeed in this role, you'll need to possess the following skills and competencies:
- Strong clinical knowledge and expertise in your field of specialty.
- Excellent communication and interpersonal skills.
- Ability to analyze complex data and make informed decisions.
- Strong problem-solving and critical thinking skills.
- Ability to work collaboratively with others, including healthcare professionals and stakeholders.
Career Growth Opportunities and Learning Benefits
As a Physician Advisor - Utilization Management with Erlanger Baroness Hospital, you'll have opportunities for career growth and professional development. You'll be able to:
- Develop your skills and expertise in utilization management and healthcare quality management.
- Stay up-to-date with the latest regulatory guidelines and industry trends.
- Collaborate with healthcare professionals and other stakeholders to drive positive outcomes.
- Participate in strategic committees and initiatives to shape the future of healthcare.
Work Environment and Company Culture
As a remote employee, you'll enjoy the flexibility and autonomy to work from anywhere. Our company culture is built on a foundation of teamwork, collaboration, and a commitment to delivering exceptional patient care. We're passionate about making a difference in the lives of our patients and the community we serve.
Compensation, Perks, and Benefits
We offer a competitive salary and benefits package, including:
- A competitive salary, commensurate with experience.
- Opportunities for professional growth and development.
- A comprehensive benefits package, including medical, dental, and vision coverage.
- Paid time off and holidays.
- A dynamic and supportive work environment.
Join Our Team
If you're a motivated and experienced Physician Advisor looking for a new challenge, we encourage you to apply for this exciting opportunity. As a Physician Advisor - Utilization Management with Erlanger Baroness Hospital, you'll play a critical role in driving healthcare excellence and delivering exceptional patient care. Don't miss this chance to join our team and make a difference in the lives of our patients.
Apply now to take the first step towards a rewarding and challenging career with Erlanger Baroness Hospital.
Apply Now