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Santa Rosa, California
Posted: 09-Jun-25
Location: Lewes, Delaware
Internal Number: 9429
Become part of the Beebe team - an inclusive team positioned in a vibrant, coastal community. Enjoy a fulfilling career as you support the health of our patients and a team focused on excellence.
Overview
The Utilization Review Physician is responsible for coordinating between case management, discharge planning, utilization review, coding team, physicians, providers, coding team, population health, and other clinical members to assist in providing cost efficient, high quality inpatient care for observation and inpatients at Beebe Medical Center facilities. This position includes assisting in policies, processes, and education around improving Patient Care and Quality metrics including although not limited to Length of Stay, cost reduction, appropriate coding, and appealing denials as appropriate.
The Utilization Review Physician will work in a dyad leadership with the Utilization Review and Case Management Leadership. Will directly report to Beebe Healthcare's Physician In Chief.
Responsibilities
?Maintains accountability for achieving favorable case management outcomes.
?Supports the medical staff in the efficient progressions of patient care.
?Reviews issues identified by case managers, utilization review to ensure appropriate follow-up and recommends improvement initiatives as needed.
?Provides consultation to the clinical team around complex clinical issues, Social Determinants of Health and advises on future action.
?Works to optimize quality of care and cost of care with direct involvement with Hospitalists and other clinical sections.
?Works with clinical team to optimize patient and team member satisfaction.
?Participates in developing and maintaining positive relationships with Medical Directors of third-party payers.
?Resolves status concerns: CODE 44/ HIMM letters. Participates in level of care determinations on a case-by-case basis as requested by case managers. Evaluates and responds to denials of payment.
?Will co-facilitate the Utilization Review Committee.
?Collaborates with coding team to educated and optimize appropriate coding and modifiers.
?Collaborates with other services such as Risk Management, Palliative Care, as needed.
?Works with Beebe Medical Center Hospitalist Program, specifically working with Medical Director and team to educate and optimize utilization, coding, and quality goals.
Qualifications
?Board eligibility of Board Certification in a Medical Specialty or Sub-Specialty.
?M.D. or D.O. medical degree.
?Minimum of 5-7 years in direct patient care.
?Active or pending certification in Health Utilization Review
Competencies Skills
"Essential:
* Clear Communication Skills Both Written And Verbal
* Able To Keep Confidential Information Regarding Patients, Team Members
* Able To Withstand Crisis Situations
* Has Skills To Provides Customer Service To Patients, Team Members And Visitors
* Knowledge And Experience With Electronic Health Records
"
Credentials
Education
Essential:
* Doctor of Medicine (MD)
Other Information
?Board eligibility of Board Certification in a Medical Specialty or Sub-Specialty.
?M.D. or D.O. medical degree.
?Minimum of 5-7 years in direct patient care.
?Active or pending certification in Health Utilization Review
Entry
USD $0.00/Hr.
Max
USD $165,949.00/Yr.
