Join CommonSpirit Health as a Utilization Management Physician Advisor II, where you'll conduct clinical case reviews and collaborate with healthcare teams to ensure quality patient care and effective utilization of services.
Key Responsibilities
Conducts medical record review for medical necessity of inpatient admission and quality care management
Understands ICD-9-CM, ICD-10-CM/PCS, MS-DRG, APR-DRG, and Medicare IPPS
Conducts peer-to-peer reviews with payer medical directors
Reviews and analyzes denied claims to determine validity and leads the appeals process
Provides feedback and education to Care Management and Clinical Documentation Departments
Attends and participates in facility committee meetings as requested
Required Qualifications
MD or DO required
Minimum 3 years of experience as a Physician Advisor managing denials
Minimum 5 years of experience in Clinical Practice
Experience performing Peer to Peer Reviews
Experience submitting written and verbal appeals
Unrestricted license in field of practice in one or more states