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Role Description

The Physician Advisor for Utilization Management of WVU Medicine works closely with the medical staff leadership and various departments to optimize the use of hospital services for all patients.

• Develop and implement methods to optimize hospital services
• Work with hospital leadership to develop utilization management protocols
• Ensure patients are in the appropriate level of care
• Support documentation and monitor the appropriate use of diagnostic and therapeutic modalities
• Represent the opinion of medical staff, third party payers, and regulatory bodies
• Assist in leading WVU Medicine’s pursuit of high standards of patient care and clinical effectiveness

Qualifications

• Doctorate of medicine from an accredited School of Medicine or Osteopathy
• Board certified by a board recognized by the American Board of Medical Specialties
• Holds or is eligible for Medical licensure in the State of West Virginia
• Minimum 5 years clinical experience in the practice of medicine is preferred

Requirements

• Provide regular input into strategic planning and resource allocation processes
• Conduct physician education sessions on data, trends, and practice patterns
• Investigate avoidable delay concerns affecting patient outcomes
• Identify denial trends and work with medical staff to resolve issues
• Submit quarterly time sheets verifying completion of contractually agreed hours
• Be a credentialed member of all system hospitals
• Represent Utilization Management at various hospital assigned committees
• Assure compliance with medical staff bylaws and regulations
• Provide education on regulatory requirements and appropriate utilization of services
• Assist in meeting regulatory guidelines and achieving quality improvement objectives
• Participate in information technology development for feedback to physicians

Benefits

• Scheduled Weekly Hours: 20
• Shift: Exempt/Non-Exempt: United States of America (Exempt)