Full Time Administration Job in New York

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Full Time Administration Job in New York

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Full Time Administration Jobs > New York > Other Locations

Administration

The Execu|Search Group

New York

Full Time

A widely recognized healthcare facility in Suffern, NY is actively seeking a self-motivated and patient-oriented Physician Advisor, with a strong Utilization Review / Case Management background, for a promising opportunity on their staff. In this role, the Utilization Review / Care Manager Physician Advisor acts as liaisons between the medical staff, clinical management, and third party payers to promote the efficient utilization of resources and to select the appropriate levels of medical care within the facility. Apply today!


The Utilization Review / Care Management Physician Advisor will:

  • Review all imaging cases in which clinical determinations cannot be made by initial clinical review
  • Discuss determination with requesting physicians or ordering providers, when available within the regulatory timeframe of the request by phone or fax
  • Provide clinical rational for standard and expedited appeals
  • Provide assistance to initial clinical reviewers as needed to discuss cases and problems
  • Participate in daily review of aggregate denials/appeals with the Medical Director, peer, and or the Clinical Review Supervisor
  • Utilize medical review guidelines and parameters to assure consistency in the MD review process so as to reflect appropriate utilization and compliance with NIA’s polices/ procedures, as well as URAC and NCQA guidelines
  • Document all communication with medical office staff and/or MD provider is recorded in a timely and accurate manner
  • Participate in on-going training per inter-rater reliability process

Required Skills:

  • Board eligibility
  • Graduate from an accredited medical school
  • Current unrestricted MD license to practice medicine  
  • 5-8 years of clinical hospital experience
  • Knowledge of CMS and Interqual regulations
  • Strong leadership skills
  • Highly organized

Your privacy is important to us. For consideration, please submit your CV in confidence and our recruiter will contact you to discuss job location and details before forwarding your CV to our client for an interview.

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