Hospitalist Medical Director of Utilization Review - 1 hour North of Boston
Seeking an experienced Hospitalist leader to conduct clinical reviews on cases referred by care management and the clinical documentation improvement specialist to assure quality patient care and effective, efficient utilization of health care services.
Meet with care management, CDIS and the health care team members to discuss selected cases and make recommendations for care, interacting with medical staff members and medical directors of third-party payers to discuss the needs of patients and alternative levels of care. Act as consultant and resource for providers regarding their decisions relative to appropriateness of hospitalization, continued stay, and use of resources.
- Report directly to the Chief Medical Officer
- Review patients records for compliance and continues progress of patients
- Assist with the patient status determination and length of stay management
- Assist with the denials management, appeals process and perform peer-to-peer payer reviews
- Review and make suggestions related to resource and service management
- Assist staff with the clinical review of patients
- Determine if standards of quality care is met
- Participate in Hospital committees to develop protocols
- Review cases that indicate a need for issuance of a hospital notice of non-coverage
- Participate in review of long stay patients, in conjunction with the Care Management leadership, Care Management team and other members of the multidisciplinary team to facilitate the use of the most appropriate level of care. Participates in patient rounds with the Healthcare team as necessary
- Identify patients who are appropriate for transfer to lower levels of care such as skilled nursing facilities (SNF), palliative care, long-term care, assisted living, long-term acute care facilities, and hospice. Works with physicians to facilitate referrals as needed
- Minimum of two-years' experience in Internal Medicine required and two or more years practicing as a Physician Advisor preferred.
- Must be Certified by the American Board of Medicine
- Licensed to practice Medicine in the State of New Hampshire
- Schedule is Monday through Friday
- Clinical responsibility is only 2-3 Hospitalist shifts per month
- Compensation is commensurate with experience
- Robust benefits package
Located in southern New Hampshire just under 1 hour from Boston. This area has an array of educational, cultural, and outdoor activities for the whole family to take advantage of. It is a gateway to the mountains of New England.
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