Physician: Case Mgmt Medical Advisor
1500 North Ritter Avenue
Indianapolis, IN 46219
The Case Management Medical Advisor position is located in Indianapolis, Indiana.
The Case Management Medical Advisor is a physician who:
- 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.
- 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 policies
Graduate of accredited medical school.
- 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
- 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.
CMMA, Case Management, Utilization Review
Community Health Network embraces a servant leadership philosophy by putting the needs of patients, employees, and the community above our own. We strongly believe to provide exceptional healthcare services we need exceptional leaders. A Community leader humbly puts the needs of others first and provides focus and direction to those they have the privilege of leading. They demonstrate compassion in all interactions and are deeply invested in the growth and development of others.