Job Description

Utilization Physician Reviewer

At BayCare, we are proud to be one of the largest employers in the Tampa Bay area. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote a forward-thinking philosophy that's built on a foundation of trust, dignity, respect, responsibility and clinical excellence.

Utilization Physician Reviewer position details:

• Facility: St. Joseph's Hospital
• Location: Tampa, FL
• Status: PRN
• Shift Hours: Varies
• Weekend Work: Every
• On Call: No
• Remote

The role of the Utilization Physician Reviewer is to optimize utilization physician review coverage resulting in reduction of inappropriate prolonged observation stays and improved patient throughput and progression of care.

• Serves as an integral team member to assess and influence clinical resource utilization in the acute care setting through collegial interaction with Utilization Review, Case Management, and Clinical Providers while aligning with organizational initiatives and priorities.
• Reports directly to the Physician Advisor Medical Director.
• Performs active and timely review of observation encounters via interactive workbooks on Microsoft Teams providing compliant and appropriate recommendations for Observation to Inpatient conversion based on medical necessity with reference to appropriate admission criteria.
• Completes Cerner Secondary Reviews in a timely fashion with appropriate documentation allowing Utilization Review Nurses to efficiently execute Secondary Review Outcomes and Payor-requested reviews.
• Helps guide the Utilization Review team to ensure proper compliance with payer regulations and policies.

Required education:

• Doctorate Medical Doctor
• Or Doctorate Osteopathic Medicine

Required credentials

• Medical Board - License

Experience:

• 5 years clinical related
• 1 year of education experience

Equal Opportunity Employer Veterans/Disabled

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