Become part of the Beebe team - an inclusive team positioned in a vibrant, coastal community. Enjoy a fulfilling career as you support the health of our patients and a team focused on excellence.
Beebe Healthcare is excited to support our teams to advance care and value for our community through the knowledge and impact of Physician Advisors.
The Utilization Review Physician is responsible for coordinating between case management, discharge planning, utilization review, coding team, physicians, providers, coding team, population health, and other clinical members to assist in providing cost efficient, high quality inpatient care for observation and inpatients at Beebe Medical Center facilities. This position includes assisting in policies, processes, and education around improving Patient Care and Quality metrics including although not limited to Length of Stay, cost reduction, appropriate coding, and appealing denials as appropriate.
The Utilization Review Physician will work in a dyad leadership with the Utilization Review and Case Management Leadership. Will directly report to Beebe Healthcare's Physician In Chief.
·Board eligibility of Board Certification in a Medical Specialty or Sub-Specialty.
·M.D. or D.O. medical degree.
·Minimum of 5-7 years in direct patient care.
·Active or pending certification in Health Utilization Review
·Maintains accountability for achieving favorable case management outcomes.
·Supports the medical staff in the efficient progressions of patient care.
·Reviews issues identified by case managers, utilization review to ensure appropriate follow-up and recommends improvement initiatives as needed.
·Provides consultation to the clinical team around complex clinical issues, Social Determinants of Health and advises on future action.
·Works to optimize quality of care and cost of care with direct involvement with Hospitalists and other clinical sections.
·Works with clinical team to optimize patient and team member satisfaction.
·Participates in developing and maintaining positive relationships with Medical Directors of third-party payers.
·Resolves status concerns: CODE 44/ HIMM letters. Participates in level of care determinations on a case-by-case basis as requested by case managers. Evaluates and responds to denials of payment.
·Will co-facilitate the Utilization Review Committee.
·Collaborates with coding team to educated and optimize appropriate coding and modifiers.
·Collaborates with other services such as Risk Management, Palliative Care, as needed.
·Works with Beebe Medical Center Hospitalist Program, specifically working with Medical Director and team to educate and optimize utilization, coding, and quality goals.
Competencies and skills: Essential: *Clear Communication Skills Both Written And Verbal *Able To Keep Confidential Information Regarding Patients, Team Members *Able To Withstand Crisis Situations *Has Skills To Provides Customer Service To Patients, Team Members And Visitors *Knowledge And Experience With Electronic Health Records
Beebe Healthcare serves the Sussex County community with a medical center located in beautiful, historic Lewes, Delaware, and convenient outpatient locations throughout the county. Founded in 1916 by two physician brothers, Drs. James Beebe and Richard C. Beebe, the medical center in Lewes is a 210-licensed-bed, not-for-profit seaside community hospital. Beebe's specialized service lines include cardiac and vascular, surgical services, oncology, women's health, and orthopaedic services. Beebe offers an array of inpatient, outpatient, emergency, and diagnostic services.
Beebe's five satellite campuses offer imaging, physical rehabilitation, and lab services, as well as walk-in care centers. In addition, Beebe offers Wound Healing & Hyperbaric Medicine and Diabetes Management & Medical Nutrition Therapy.
With a mission to serve the community, Beebe also offers many free screenings and outreach programs through its Population Health Department; and advanced medical care for those who are recuperating at home through Beebe Home Care Services.
Beebe is also training the next generation of nurses through the Margaret H. Rollins School of Nursing, located behind the Medical Cente...r in Lewes.
Beebe's Medical Staff has grown tremendously since the early 1990s. Employed physicians through Beebe Medical Group and our affiliated physicians on Beebe's Medical Staff now serve patients from Milford to Millville in specialties including cardiac surgery, dermatology, endocrinology, family practice, gastroenterology, general surgery, internal medicine, pediatric neurology, and surgical oncology.
Beebe is proud to offer quality care, close to home for the residents and visitors of Sussex County.