University of Utah Health HP Medical Review Officer in murray, Utah
As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, diversity, integrity, quality and trust that are integral to our mission. EO/AA
The University of Utah Health Plans (UUHP) Medical Review Officer functions as the clinician resource for utilization management determinations as part of a team responsible for care management, utilization management and pharmacy utilization decisions. This individual will also assist the plan in managing appropriate resource utilization in an effort to maintain appropriate coverage decisions consistent with plan policies and guidance and in accordance with NCQA and other regulatory bodies.
Responsible for case review of utilization management prior auth or post-service adjudication cases so as to complete case review in a timely fashion c/w standards established by the plan and aligned with NCQA or other regulatory bodies pertinent to the plan function
Experience to make medical judgments regarding appropriateness of care, length of stay and medical necessity and the ability to promote physician/provider compliance with, recognized national guidelines, clinical pathways and protocols and develop quality improvement strategies. Develop and review medical criteria and best practice standards related to utilization review (pre and post service review) for all service lines.
Regular attendee to appropriate meetings designed to assure inter-rater review process and to stay abreast of policy changes, plan design changes and to integrate functions with the utilization/care management staff so as to afford smooth functioning of these various areas.
Other duties as assigned by Chief Medical Officer or his/her designee
Knowledge / Skills / Abilities
Ability to use electronic media in managing case review such as InterQual guidelines, EPIC Tapestry and others
Excellent communications skills to interface with providers, staff, and management.
Able to manage difficult peer situations arising from medical care review.
Appreciation of cultural diversity and sensitivity towards target population.
Current licensure to practice medicine in the State of Utah
Board Certification by an approved ABMS board
Minimum 5 years of clinical practice
Sitting, Standing, Walking
Requisition Number 28671
Employment Type PRN
Work Schedule Days
Location Name University of Utah Health Plans
Patient Care? ..
Department UIP CST 01H UUHP CLINICAL OPRN
Category Insurance / Health Plans
The University of Utah Health Care is an Affirmative Action/Equal Opportunity employer. Upon request, reasonable accommodations in the application process will be provided to individuals with disabilities. The University of Utah Health Care is committed to diversity in its workforce. Women and minorities are encouraged to apply.