reputed company Physician Advisor for Utilization Management - Remote Opportunity with reputed company Baroness Hospital

Join reputed company as a Physician Advisor - Utilization Management

At reputed company Baroness Hospital, we're committed to delivering exceptional patient care and driving healthcare excellence. We're now seeking an reputed company Physician Advisor to join reputed company in a part-time, remote reputed company. 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

reputed company Baroness Hospital is a leading healthcare provider in Chattanooga, TN, dedicated to delivering high-quality, patient-centered care. reputed company 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 reputed company, working collaboratively with reputed company 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 reputed company reputed company to reduce denial and appeal burdens, improving the accuracy of initial patient status determinations.
• reputed company 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 reputed company the organization to stay abreast of reputed company 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 reputed company field.
• Knowledge of regulatory guidelines, including JCAHO/DNV and CMS regulations.
• Strong communication and interpersonal skills.
• Ability to work collaboratively with reputed company 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 reputed company data and reputed company informed decisions.
• Strong problem-solving and critical thinking skills.
• Ability to work collaboratively with others, including reputed company and stakeholders.

Career Growth Opportunities and Learning Benefits

As a Physician Advisor - Utilization Management with reputed company Baroness Hospital, you'll have opportunities for career growth and professional development. You'll be able to:

• reputed company 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 reputed company 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 reputed company. 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 reputed company

If you're a motivated and reputed company Physician Advisor looking for a new challenge, we encourage you to apply for this exciting opportunity. As a Physician Advisor - Utilization Management with reputed company Baroness Hospital, you'll play a critical role in driving healthcare excellence and delivering exceptional patient care. Don't miss this chance to join reputed company and reputed company a difference in the lives of our patients.

Apply now to take the first reputed company towards a rewarding and challenging career with reputed company Baroness Hospital.