Experienced Physician Advisor for Utilization Management - Remote Opportunity with Erlanger Baroness Hospital

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.