What are the responsibilities and job description for the Medical Doctor (Yonkers, NY, Us) position at Montefiore?
The Utilization Management Physician Advisor [UMPA] works in collaboration with utilization management, quality, and clinical teams to ensure all patients at Montefiore Medical Center receive medically necessary, clinically appropriate, well documented and high-quality care. The UMPA performs medical necessity reviews, determines clinical appropriateness of care, examines resource utilization, and conducts reconsiderations [also called peer to peer] discussions with payors' medical directors for the purpose of obtaining inpatient authorizations when the payor intends to deny the authorization. S/he communicates to the clinical teams to ensure the record reflects the severity of the patients illness and reason for admission. S/he acts as a resource to clinical, care management and non-clinical staff and identifies opportunities for process improvement. S/he is knowledgeable of CMS and New York State facility performance data and associated regulatory and payer requirements associated with medical necessity, utilization, accurate clinical documentation and patient status.
New York Medical Doctor License with a valid registration.
A minimum of 5 years inpatient acute care clinical experience [excluding Obstetrics, Newborn, Neonatology or Acute Rehabilitation].
Department: CMO Bargaining Unit: Non Union Campus: YONKERS Employment Status: Regular Full-Time Address: 200 CORPORATE DRIVE, Yonkers
Shift: Day Scheduled Hours: 8:30 AM-5 PM Req ID: 210127 Salary Range/Pay Rate: $168,750 - $225,000.00
For positions that have only a rate listed, the displayed rate is the hiring rate but could be subject to change based on shift differential, experience, education or other relevant factors.
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