Job description
Ensures documentation, data capture and opportunities for utilization are compliant, accurate and consistent.
- Works in collaboration with the Medical Director of Centralized UR/HIM, utilization committees and medical staff to maintain and improve utilization and documentation efforts.
- Serves as a resource to the medical staff for Utilization Review activities. Educates and communicates to the Medical staff the benefits/need for utilization review and documentation.
- Performs regular, follow-up and focused chart audits/reviews (concurrent and retrospective) for the purpose of assessing the accuracy of clinical documentation and utilization. Ability to work weekends and holidays as needed.
- Makes decisions on referred individual patient cases regarding: Pre-admission, authorization, Medical necessity and services/setting, transfers, appropriateness of admission, and continued stay. Conducts peer to peer discussions with health plans when required.
Essential:
- Accredited School of Medicine
Essential:
- Osteopathic Physician License - FL
- Medical Doctor License - FL
Education equivalent experience:
Essential:
- Graduate of a medical school approved by the Council on Medical Education of the American Medical Association.
Complexity of Work: Requires critical thinking skills, effective communication, decisive judgment and the ability to work with minimal supervision. The incumbent must be able to work in a stressful environment and take appropriate action when required.
Required Work Experience: Minimum of 1 year of work experience in a clinical setting
Prior experience in Utilization Management with hospital system or health system preferred
Essential:
- Bending and Stooping 60.00%
- Climbing 40.00%
- Keyboard Entry 100.00%
- Kneeling 40.00%
- Lifting or Carrying 0 - 25 lbs Non-Patient 60.00%
- Pushing or Pulling 0 - 25 lbs Non-Patient 60.00%
- Reaching 60.00%
- Repetitive Movement Foot/Leg 40.00%
- Repetitive Movement Hand/Arm 100.00%
- Sitting 100.00%
- Squatting 80.00%
- Standing 80.00%
- Walking 80.00%
- Audible Speech 100.00%
- Hearing Acuity 100.00%
- Depth Perception 60.00%
- Distinguish Color 60.00%
- Seeing - Far 60.00%
- Seeing - Near 60.00%
- Bio hazardous Waste 40.00%
- Blood and/or Bodily Fluids 40.00%
- Computer Monitor 80.00%
- Domestic Animals 40.00%
- Extreme Heat/Cold 40.00%
- Potential for Physical Assault 40.00%
Since its inception in 1953, Memorial Healthcare System has been a leader in providing high-quality healthcare services to South Florida residents. Today, it is one of the largest public healthcare systems in the nation with over 13,000 team members and highly regarded for its exceptional patient- and family-centered care. Memorial's patient, physician and employee satisfaction rates are some of the most admired in the country, and the system is recognized as a national leader in quality healthcare.
Memorial has a reputation as one of Florida's leading healthcare systems and is supported by a distinguished medical staff. In fact, the vast majority of physicians are board certified or board qualified in their specialties and have been trained at many of the nation's finest medical schools and hospitals. Because of its distinguished medical staff and services, Memorial draws patients from South Florida and beyond.
Many prestigious healthcare awards have been earned by Memorial Healthcare System and its facilities. The accolades include: Modern Healthcare magazine's Best Places to Work in Healthcare, Florida Trend magazine's Best Companies to Work for in Florida, 100 Top Hospitals, Consumer Choice Award, Best-Run Hospital, Best Nursing Staff, Best Pediatric Hospital and Best Maternity Hospital.
jjbodyshop.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, jjbodyshop.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, jjbodyshop.com is the ideal place to find your next job.