Physician Advisor-Utilization Management

• JOB SUMMARY/PURPOSE

  • Provides medical consultation and utilization management case review at Samaritan Health Services Hospitals. Acts as a liaison with medical staff and hospital administration regarding admission, discharge, and length of stay and service utilization decisions.

• DEPARTMENT DESCRIPTION

  • The Utilization Management team is a centralized team of physicians, nurses and specialists that perform admission and continued stay compliance reviews for all Samaritan Hospitals. Utilization Management nurses and physicians are specially trained in Medicare and commercial insurance regulations, perform reviews on all admitted patients and provide staff and physician education. The Utilization Management team communicates information to insurance companies to assure payment of hospital services.

• EXPERIENCE/EDUCATION/QUALIFICATIONS

  • MD or DO degree required.
  • Board Certification in the practice specialty required.
  • Unrestricted license to practice medicine in the State of Oregon required.
  • Strong broad based clinical background with five (5) years of medical experience caring for adult patients in a hospital setting required.
  • Three (3) years experience in similar areas of accountability preferred.
  • Experience with computer applications, electronic medical records, other medical programs and electronic medical literature required.
  • Experience with hospital Utilization Review, Medicare regulations and health insurance policies preferred.
  • Experience efficiently researching, analyzing and summarizing complex clinical topics preferred.

• KNOWLEDGE/SKILLS/ABILITIES

  • Medicine - Possess the skills and knowledge needed to review clinical documentation regarding human injuries, diseases, and/or behavioral conditions. Ability to recognize symptoms, understand drug properties and interactions and evaluate the treatment planned or provided by other SHS providers.
  • Compliance - Ability to evaluate information to determine compliance with laws, regulations, or standards in the clinical and utilization management areas of responsibility. Uses clinical and regulatory knowledge to verify compliant process application.
  • Business Writing - Strong business writing skills, including the ability to professionally communicate clinical content in written/typed documentation that is easily understood by the end user. Ability to use a computer for required documentation.
  • Communication - Effective written and oral communication skills to explain complex medical and regulatory issues, exchange information between team members, and tactfully discuss and teach utilization management and compliance concepts. Ability to listen and understand complex information and ideas.
  • Conflict resolution - Influences others to build consensus and gain cooperation. Proactively resolves conflicts in a positive and constructive manner.

• PHYSICAL DEMANDS

  • Rarely
    (1 - 10% of the time)

    Occasionally
    (11 - 33% of the time)

    Frequently
    (34 - 66% of the time)

    Continually
    (67 – 100% of the time)

    CLIMB - STAIRS

    LIFT (Floor to Waist: 0"-36") 20 - 40 Lbs

    LIFT (Floor to Waist: 0"-36") 40 - 60 Lbs

    LIFT (Floor to Waist: 0"-36") 60 or more Lbs

    LIFT (Knee to chest: 24"-54") 0 – 20 Lbs

    LIFT (Waist to Eye: up to 54") 0 - 20 Lbs

    LIFT (Overhead: 54" and above) 0 - 20 Lbs

    CARRY 1-handed, 0 - 20 pounds

    CARRY 2-handed, 0 - 20 pounds

    CARRY 2-handed, 20 - 40 pounds

    SQUAT Static (hold >30 sec)

    SQUAT Repetitive

    KNEEL (on knees)

    REACH - Upward

    PUSH (0 - 20 pounds force)

    PULL (0 - 20 pounds force)

    PUSH (20 - 40 pounds force)

    PULL (20 - 40 pounds force)

    Enter and Exit Vehicle

    STAND

    WALK – LEVEL SURFACE

    LIFT (Floor to Waist: 0"-36") 0 - 20 Lbs

    ROTATE TRUNK Sitting

    ROTATE TRUNK Standing

    BEND FORWARD at waist

    REACH - Forward

    PINCH Fingers

    GRASP Hand/Fist

    SIT

    MANUAL DEXTERITY Hands/wrists

    FINGER DEXTERITY

Location: Samaritan Health Services · SHS Utilization Management
Schedule: Casual, Day