Utilization Management Physician Advisor - Intermountain Health
San Juan, PR
About the Job
Job Description:
Physician will provide Physician Advisor Utilization Reviewer and Central Appeals Work services. Physician shall engage, educate, and coach physicians and other clinicians in appropriate documentation of medical necessity for hospital admissions and other diagnostic and therapeutic interventions in IHCHS hospitals and/or geographic regions as assigned.
Physician shall work in partnership with the utilization review committee to ensure procedures are in place to follow all rules and regulations and maintain compliance. Physician shall serve as an expert and local resource to hospital Case Management Department and Medical Staff on issues relating to clinical documentation and medical necessity. In addition, Physician shall work closely with the Medical Director (Executive/Community/Rural), Nursing Administrator, Case Management Director, and Finance Director.
+ Work with and support the Case Management Department to ensure appropriate admission and discharge status and timing.
+ Be a consistent resource for physicians and case managers on issues relating to clinical documentation, appropriate admission status, and patient flow.
+ Provide oversight and coordination of physician education and coaching on regulatory issues.
+ Participate and provide physician expertise for appeals in coordination with R1 Central Appeals Unit (“CAU”).
+ Attend System Utilization Review (“UR”) Committee and provide Regional Physician Advisor Educators information to be shared at Regional UR Committees as assigned.
+ Perform high level utilization review on a population basis to help guide compliance and educational efforts.
+ Work with other IHCHS Physician Advisors and provide service to other regions as needed.
+ Work under direct supervision of the IHCHS Chief Patient Experience Officer and IHCHS System Physician Advisor.
+ Participate in other IHCHS meetings as needed.
+ Add Utilization Review shifts as directed by System Physician Advisor.
+ Oversee Intermountain Physician Advisor Services (“IPAS”) Utilization Review physicians and nurses in conjunction with System Physician Advisor.
+ Coordinate Tertiary Review schedule and completion. Physician will need to arrange for another IPAS physician to be on-call as the second IPAS reviewer for those cases where Physician is the original IPAS reviewer and a second IPAS reviewer is required.
+ Obtain and distribute pertinent UR data to IPAS UR team and IHCHS leadership as appropriate.
+ Oversee IPAS UR physicians and nurses to arrange monthly meetings, agendas, schedule and ad hoc education in conjunction with System Physician Advisor.
+ Work with System Utilization Review Manager and others to adjust UR workflow to reflect current trends and documentation requirements.
+ Give feedback to IPAS UR physicians and Case Management regarding denials to enable adjustments to front-end practice.
Minimum Requirements:
+ Medical Doctor or Doctor of Osteopathic Medicine Degree. Education must be obtained through an ACGME or AOA accredited institution. Degree will be verified.
+ ABMS or equivalent AOA Board Certification
+ Active state license.
+ Two years of experience leading successful improvements in clinical settings.
+ Experience with change management with the ability to provide leadership in the adaptation and implementation of new processes or technology that enhance safety.
+ Effective verbal, written, and interpersonal communication skills.
+ Ability to work remotely
Physical Requirements:
+ Interact with others requiring employee to verbally communicate as well as hear and understand spoken information.
+ Operate computers, telephones, office equipment, and manipulate paper requiring the ability to move fingers and hands.
+ See and read computer monitors and documents.
+ Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.
Preferred Qualifications:
+ Trained in improvement science (i.e., Six Sigma, Lean, Project management, Advanced Training Program).
+ Experience working in a complex health system (e.g., hospitals, ambulatory clinics, post-acute care).
+ Demonstrated leadership of clinicians.
Physical Requirements:
Anticipated job posting close date:
06/20/2027
Location:
Peaks Regional Office
Work City:
Broomfield
Work State:
Colorado
Scheduled Weekly Hours:
40
The hourly range for this position is listed below. Actual hourly rate dependent upon experience.
$1.00 - $1,000.00
We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.
Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers (https://intermountainhealthcare.org/careers/working-for-intermountain/employee-benefits/) , and for our Colorado, Montana, and Kansas based caregivers (http://www.sclhealthbenefits.org) ; and our commitment to diversity, equity, and inclusion (https://intermountainhealthcare.org/careers/working-for-intermountain/diversity/) .
Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
Physician will provide Physician Advisor Utilization Reviewer and Central Appeals Work services. Physician shall engage, educate, and coach physicians and other clinicians in appropriate documentation of medical necessity for hospital admissions and other diagnostic and therapeutic interventions in IHCHS hospitals and/or geographic regions as assigned.
Physician shall work in partnership with the utilization review committee to ensure procedures are in place to follow all rules and regulations and maintain compliance. Physician shall serve as an expert and local resource to hospital Case Management Department and Medical Staff on issues relating to clinical documentation and medical necessity. In addition, Physician shall work closely with the Medical Director (Executive/Community/Rural), Nursing Administrator, Case Management Director, and Finance Director.
+ Work with and support the Case Management Department to ensure appropriate admission and discharge status and timing.
+ Be a consistent resource for physicians and case managers on issues relating to clinical documentation, appropriate admission status, and patient flow.
+ Provide oversight and coordination of physician education and coaching on regulatory issues.
+ Participate and provide physician expertise for appeals in coordination with R1 Central Appeals Unit (“CAU”).
+ Attend System Utilization Review (“UR”) Committee and provide Regional Physician Advisor Educators information to be shared at Regional UR Committees as assigned.
+ Perform high level utilization review on a population basis to help guide compliance and educational efforts.
+ Work with other IHCHS Physician Advisors and provide service to other regions as needed.
+ Work under direct supervision of the IHCHS Chief Patient Experience Officer and IHCHS System Physician Advisor.
+ Participate in other IHCHS meetings as needed.
+ Add Utilization Review shifts as directed by System Physician Advisor.
+ Oversee Intermountain Physician Advisor Services (“IPAS”) Utilization Review physicians and nurses in conjunction with System Physician Advisor.
+ Coordinate Tertiary Review schedule and completion. Physician will need to arrange for another IPAS physician to be on-call as the second IPAS reviewer for those cases where Physician is the original IPAS reviewer and a second IPAS reviewer is required.
+ Obtain and distribute pertinent UR data to IPAS UR team and IHCHS leadership as appropriate.
+ Oversee IPAS UR physicians and nurses to arrange monthly meetings, agendas, schedule and ad hoc education in conjunction with System Physician Advisor.
+ Work with System Utilization Review Manager and others to adjust UR workflow to reflect current trends and documentation requirements.
+ Give feedback to IPAS UR physicians and Case Management regarding denials to enable adjustments to front-end practice.
Minimum Requirements:
+ Medical Doctor or Doctor of Osteopathic Medicine Degree. Education must be obtained through an ACGME or AOA accredited institution. Degree will be verified.
+ ABMS or equivalent AOA Board Certification
+ Active state license.
+ Two years of experience leading successful improvements in clinical settings.
+ Experience with change management with the ability to provide leadership in the adaptation and implementation of new processes or technology that enhance safety.
+ Effective verbal, written, and interpersonal communication skills.
+ Ability to work remotely
Physical Requirements:
+ Interact with others requiring employee to verbally communicate as well as hear and understand spoken information.
+ Operate computers, telephones, office equipment, and manipulate paper requiring the ability to move fingers and hands.
+ See and read computer monitors and documents.
+ Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.
Preferred Qualifications:
+ Trained in improvement science (i.e., Six Sigma, Lean, Project management, Advanced Training Program).
+ Experience working in a complex health system (e.g., hospitals, ambulatory clinics, post-acute care).
+ Demonstrated leadership of clinicians.
Physical Requirements:
Anticipated job posting close date:
06/20/2027
Location:
Peaks Regional Office
Work City:
Broomfield
Work State:
Colorado
Scheduled Weekly Hours:
40
The hourly range for this position is listed below. Actual hourly rate dependent upon experience.
$1.00 - $1,000.00
We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.
Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers (https://intermountainhealthcare.org/careers/working-for-intermountain/employee-benefits/) , and for our Colorado, Montana, and Kansas based caregivers (http://www.sclhealthbenefits.org) ; and our commitment to diversity, equity, and inclusion (https://intermountainhealthcare.org/careers/working-for-intermountain/diversity/) .
Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
Source : Intermountain Health