Job LocationThe Case Management Medical Advisor position is located in Indianapolis, Indiana.Job Duties- The Case Management Medical Advisor serves as a resource to the Case Management staff on medical necessity, level of care, care progression, denial management, and resource utilization as well as a liaison to the Medical Staff for Case Management operations.- Conducts clinical review on cases referred by Case Management staff and/or other health care professionals in accordance with the hospital's established Utilization Management Plan.- Meets the hospital's objectives for assuring quality patient care and effective, efficient utilization of health care services while also meeting regulatory requirements.- Meets with Case Management and health care team members to discuss selected cases and make recommendations related to care progression.- Interacts with medical staff members and medical directors of third party payers to discuss the needs of patients, access to care and alternative levels of care.- Acts as consultant and resource to attending physicians regarding their decisions relative to appropriateness of hospitalization, continued stay, and appropriate use of resources.- Acts as consultant and resource to the medical staff regarding federal and state utilization and quality regulations.Skills- Proven capability to communicate and to develop positive relationships with physician colleagues- Demonstrates objectivity, flexibility, and tact in dealing with potentially sensitive medical staff issues, practice patterns, and clinical resource utilization- Proficient technical skills to include electronic medical record and computer software skills- Demonstrates knowledge, use, and support of protocols, practice guidelines, etc.
Experience- Minimum of five years of experience in hospital acute care- Experience in Utilization management and familiarity with its principles is preferred- Experience in managed care contracting and familiarity with Medicare and managed care reimbursement policiesEducationGraduate of accredited medical school.License- Must hold an unlimited license to practice medicine in Indiana- Board Certification in internal medicine or family medicine- Qualified as a Provider under Medicare or Medicaid Programs- Current staff privileges or ability to be credentialed for staff privileges at Community Health Network Hospitals
Ranked among the nation's most integrated healthcare systems, Community Health Network is Central Indiana's leader in providing convenient access to exceptional healthcare services, where and when patients need them – in hospitals, health pavilions and doctor's offices, as well as workplaces, schools and homes. Exceptional care, simply delivered.
Community is a non-profit health system that is ...deeply committed to the communities we serve with more than 200 sites of care and affiliates throughout Central Indiana. Guided by our PRIIDE Values – Patients First, Relationships, Integrity, Innovation, Dedication and Excellence – our team of caregivers is committed to providing an exceptional experience with every life we touch.
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