Case Manager
Mindoula
Medical Director, Physician Advisor – UM
AdventHealth
full-time
Posted on:
Origin: • 🇺🇸 United States • Florida
Visit company websiteJob Level
Lead
Tech Stack
Go
About the role
- Provide primary support for Utilization Management (UM) and secondary support for Care Management (CM) departments
- Serve as a liaison between UM and CM teams and medical staff and act as medical liaison for payor escalations
- Educate, inform and advise Utilization Management, Care Management, Managed Care and Revenue Cycle departments and applicable medical staff
- Collaborate with other disciplines to improve clinical documentation, patient safety, and quality outcomes
- Provide clinical review of utilization, claims management, and quality assurance for inpatient care, outpatient/observation stays and referral services
- Serve as a contact for clinicians, external providers, contracted health insurance payors, and regulatory agencies
- Act as subject matter expert providing clinical expertise and business direction for medical management programs to promote high-quality, patient-focused, cost-effective care
- Develop relationships with physicians and stakeholders, provide education, clarify clinical questions, and support ACO activities and program development
Requirements
- Graduate of accredited Medical School
- Bachelor of Science
- Minimum of 5 years of experience in hospital medicine in acute care setting
- Current and valid license as a physician
- Board certified and eligible for membership on the Hospital medical staff
