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Physician Advisor of Utilization Review and Case Management - Burlington, United States - Beth Israel Lahey Health
Description
When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives.
Job Type:
Regular
Scheduled Hours:
20
Work Shift:
Day (United States of America)
Position Summary:
Reporting directly to the Chief Medical Officer (CMO), the Physician Advisor will play an active role in optimizing healthcare resource utilization, ensuring quality, patient care, and managing valuable organizational resources.
The role will involve collaborating with key stakeholders of multidisciplinary teams-Nursing staff leadership, hospitalist and closely collaborates with the director of care transitions to assess and guide the appropriate utilization of medical services while maintaining compliance with all regulatory requirements.
The Physician Advisor is responsible for assisting the organization to challenge physician practices to achieve the organization's desired resource management and quality goals.
Job Description:
Purpose:
Provide leadership and expertise relative to the level of care management, concurrent and retro commercial payer validation of medical necessity recommendations, as requested
Policy Setting Responsibilities
Responsible for utilization review and medical necessity recommendations, as requested
Decision-Making Authority:
Responsible for collaborating with the utilization review department as these issues relate to commercial payers, to meet established goals and for leading physician participation and compliance with responsibilities.
Supervisory Responsibility:
Responsible for engaging physicians in utilization review and medical necessity activities
Key responsibilities:
Utilization review and inpatient clinical optimization: (include all utilization review, patient status, observation, escalation, second level and peer to peer reviews.
FLSA Status:
Exempt
As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities.
Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment.
