Samaritan Health Services

Physician Advisor-Utilization Management

Samaritan Health Services • $210K — $250K *
Corvallis, OR 97330In-Person
Hospitals & Medical Centers
5 - 7 years of experience
Today
Be an Early Applicant
Job Overview by Ladders

Qualifications

  • MD or DO degree required
  • Board Certification in the practice specialty required
  • Unrestricted license to practice medicine in Oregon required
  • Five years of medical experience caring for adult patients in a hospital setting
  • Experience with computer applications and electronic medical records required
  • Preferably experienced in hospital Utilization Review and Medicare regulations
  • Experience in efficiently researching and summarizing complex clinical topics preferred

Responsibilities

  • Provide medical consultations and utilization management case reviews
  • Act as a liaison between medical staff and hospital administration
  • Review and ensure compliance with admission, discharge, and length of stay decisions
  • Educate staff and physicians on utilization management processes
  • Communicate with insurance companies to assure payment of hospital services
  • Analyze clinical documentation to maintain compliance

Benefits

  • Comprehensive healthcare coverage
  • Professional development opportunities
  • Supportive work environment with a centralized team
  • Participation in a well-structured and collaborative Utilization Management team
  • Access to continuing education and training programs
Full Job Description
  • 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

About Samaritan Health Services

Samaritan Health Services is a not-for-profit network of hospitals, clinics and health services caring for more than 250,000 residents in the mid-Willamette Valley and central Oregon Coast. It is based in Corvallis, Oregon and has facilities in Albany, Lebanon, Newport, Lincoln City and Waldport. The health system includes five hospitals, more than 80 primary care and specialty clinics, senior living communities, and home health and hospice services. Samaritan Health Services is affiliated with the Oregon Health & Science University School of Medicine and is a partner in the OHSU Partners network. The health system is also a member of the Mayo Clinic Care Network.
Learn more about Samaritan Health Services
Size
5,500 employees
Industry
Healthcare
Founded
1970
* Ladders Estimates

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