Address
Form of workDepartment:
11216 IL Revenue Cycle - Utilization Management PBAdvisors
Status:
Full time
Benefits Eligible:
Yes
Hours Per Week:
40
Schedule Details/Additional Information:
Position Requirements:Current Illinois state medical license to practice medicine and eligibility for active membership on the hospital`s medical staff. Doctorate Degree in Medicine or Doctorate Degree of Osteopathic Medicine . Minimum 5 years of clinical experience. Clinical Documentation Improvement and Utilization Management experience as a member of the UM oversight committee or past Physician Advisor experience preferred. Graduate of an accredited medical school. Additional education in Quality Utilization Management and documentation improvement / integrity through continuing medical education. programs and self- study. Knowledge of national medical necessity criteria and ICD-10 coding guidelinesPurpose:The System Physician Advisor is a lead clinician in partnership with the site physician advisors and Utilization Management (UM) and Denials leadership and team members for managing the efficiency of patient care of the health system. Acts as resource to Utilization Management (UM) staff and conducts clinical review on cases referred by UM / Denial staff and/or other health care professionals in accordance with the system/hospital objectives for effective efficient utilization of heath care services/resources appropriate level of care monitoring the appropriate use of diagnostic and therapeutic modalities appropriateness of hospitalization continued stay and to meet regulatory requirements. Interacts with various payers whose beneficiaries are admitted to Advocate Aurora hospitals. Serves as a resource to the Revenue Cycle denials / appeals staff . Interacts with site physician advisors and serves as an additional resource to the site`s Care Management (CM) staff.Accountabilities:Demonstrates knowledge of nationally recognized medical necessity criteria and ICD-10 guidelines. Maintains current knowledge of federal state and payer regulatory and contract requirements. Attends continuing education sessions pertaining to utilization and quality managementUtilizati
Advocate Aurora Health is one of the 10th largest not-for-profit, integrated health systems in the U.S. with nearly 3 million patients served at more than 500 sites of care in Illinois and Wisconsin, including 28 hospitals. We're redefining the standard for care with world-class doctors and caregivers, innovative solutions, outstanding outcomes, and leading-edge research and clinical trials. Combined, Advocate and Aurora are recognized for clinical excellence in a variety of specialties. Advocate Aurora Health is one of the 10th largest not-for-profit, integrated health systems in the U.S. with nearly 3 million patients served at more than 500 sites of care in Illinois and Wisconsin, including 28 hospitals. We're redefining the standard for care with world-class doctors and caregivers, innovative solutions, outstanding outcomes, and leading-edge research and clinical trials. Combined, Advocate and Aurora are recognized for clinical excellence in a variety of specialties.
11216 IL Revenue Cycle - Utilization Management PBAdvisors
Status:
Full time
Benefits Eligible:
Yes
Hours Per Week:
40
Schedule Details/Additional Information:
Position Requirements:Current Illinois state medical license to practice medicine and eligibility for active membership on the hospital`s medical staff. Doctorate Degree in Medicine or Doctorate Degree of Osteopathic Medicine . Minimum 5 years of clinical experience. Clinical Documentation Improvement and Utilization Management experience as a member of the UM oversight committee or past Physician Advisor experience preferred. Graduate of an accredited medical school. Additional education in Quality Utilization Management and documentation improvement / integrity through continuing medical education. programs and self- study. Knowledge of national medical necessity criteria and ICD-10 coding guidelinesPurpose:The System Physician Advisor is a lead clinician in partnership with the site physician advisors and Utilization Management (UM) and Denials leadership and team members for managing the efficiency of patient care of the health system. Acts as resource to Utilization Management (UM) staff and conducts clinical review on cases referred by UM / Denial staff and/or other health care professionals in accordance with the system/hospital objectives for effective efficient utilization of heath care services/resources appropriate level of care monitoring the appropriate use of diagnostic and therapeutic modalities appropriateness of hospitalization continued stay and to meet regulatory requirements. Interacts with various payers whose beneficiaries are admitted to Advocate Aurora hospitals. Serves as a resource to the Revenue Cycle denials / appeals staff . Interacts with site physician advisors and serves as an additional resource to the site`s Care Management (CM) staff.Accountabilities:Demonstrates knowledge of nationally recognized medical necessity criteria and ICD-10 guidelines. Maintains current knowledge of federal state and payer regulatory and contract requirements. Attends continuing education sessions pertaining to utilization and quality managementUtilizati
Advocate Aurora Health is one of the 10th largest not-for-profit, integrated health systems in the U.S. with nearly 3 million patients served at more than 500 sites of care in Illinois and Wisconsin, including 28 hospitals. We're redefining the standard for care with world-class doctors and caregivers, innovative solutions, outstanding outcomes, and leading-edge research and clinical trials. Combined, Advocate and Aurora are recognized for clinical excellence in a variety of specialties. Advocate Aurora Health is one of the 10th largest not-for-profit, integrated health systems in the U.S. with nearly 3 million patients served at more than 500 sites of care in Illinois and Wisconsin, including 28 hospitals. We're redefining the standard for care with world-class doctors and caregivers, innovative solutions, outstanding outcomes, and leading-edge research and clinical trials. Combined, Advocate and Aurora are recognized for clinical excellence in a variety of specialties.
