Utilization Review Physician Advisor

Incidental activities which include liaison with Medical Staff at committee and service meetings, as well as general liaison with AAMC administrative and UR program staff, are to include: (1) discussion with physicians regarding patient management; (2) meeting with AAMC personnel (e.g., OB/GYN Service or clinical pathway meetings); and (3) preparation of appeals and summaries for Medical Staff education. These incidental activities do not include Medical Staff committee assignments which are part of regular Medical Staff duties.

Evaluates medical record information and consults with attending physicians/practitioners to determine medical necessity of acute hospital setting.

Educates physicians about third party payer criteria and medical record documentation to support acute hospital setting.

Makes coverage decisions for billing purposes.

Authorizes HINN (Hospital Issued Notice of Non-Coverage) transferring financial liability for hospital stay to patient.

Performs expedite appeal with Health Plan medical directors.

Conducts physician peer review for cases failing to meet Interqual criteria.

Required Minimum Education: Graduate of an accredited school of medicine (Doctor degree).

Required: The employee must be licensed to practice in the State of Maryland and preferably Board Certified/ Board Eligible in Internal medicine or a comparable adult medical specialty. The employee must also fulfill the requirements for medical staff membership at Anne Arundel Medical Center. It is anticipated that on an average the provider will work as indicated in their signed employment agreement with Anne Arundel Medical Center.

Required License/Certifications: 

• None

Working Conditions, Equipment, Physical Demands:

There is a reasonable expectation that employees in this position will not be exposed to blood-borne pathogens.

Physical Demands -

The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.

The above job description is an overview of the functions and requirements for this position.  This document is not intended to be an exhaustive list encompassing every duty and requirement of this position; your supervisor may assign other duties as deemed necessary.