We are looking for a driven, tech savvy Physician Advisor with a background in efficiency that can perform utilization reviews.
The Physician Advisor will lead the organization in appropriate resource utilization to meet regulatory requirements with regards to Medicaid Acute Care claims. This Physician Advisor will collaborate with other clinical support staff to assure patients are managed in the most cost effective appropriate level of care and within regulatory requirements. This Physician Advisor will make recommendations with regards to high utilizing providers to make appropriate practice pattern changes.
The Physician Advisor will conduct clinical reviews on cases referred by the Utilization review staff of nurses and/or other health care professionals to assure cases meet regulatory requirements and are in accordance with Medicaid’s objectives for assuring quality patient care and effective, efficient utilization of health care services.
The Physician Advisor meets with utilization review staff and health care team members to discuss selected cases and make recommendations for care, interacting with medical staff members and representatives of the Maryland Department of Health and Mental Hygiene. The Physician Advisor further acts as a resource for the medical staff regarding state utilization and quality regulations.
Experience Required: Entry Level
Location: Columbia, MD
Type: Full Time