Job Description
Inova Fairfax Medical Campus is looking for a dedicated physician advisor to join the Utilization Review Advisor team. This role will be full‑time on‑site position. This role is available as a remote/ hybrid position
The Utilization Review Physician Advisor (Advisor) position conducts timely and compliant medical necessity reviews and assists with denials management (facilitating and completing peer to peers, writing appeal letters) in support of the centralized system Utilization Review (UR) process for Inova hospital facilities. The Advisor serves an important role in ensuring compliant hospital status/billing for hospital patients. The Advisor interfaces directly with UR nurses and medical staff, providing concurrent communication and education regarding recommended changes in hospital status, pertinent regulatory requirements and guidance impacting the determination, as well as documentation integrity to support medical necessity of services being delivered.
Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation.
MD Physician Advisor Job Responsibilities
Perform timely and compliant medical necessity reviews, providing clear documentation of the pertinent details of the case to satisfy regulatory requirements and directly communicate any necessary changes
Recommend and request additional, more complete, medical record documentation
Provide guidance to internal and external staff regarding status issues and alternatives to acute level of care when such care is not warranted
Work closely with revenue cycle, managed care and to support system initiatives
Attend and participate in Hospital UM committees at designated sites
Provide education to internal and external staff related to regulatory requirements, appropriate utilization, and alternative levels of care
Complete training and continuing education as deemed necessary
Attend and participate in educational presentations to medical staff, administration, leadership and peers
Additional functions as required
MD Physician Advisor Additional Requirements
Completion of an accredited residency training program
Active and unrestricted state Virginia medical license
Board certification in specialty required at time of hire
Possess or acquire a working knowledge of CMS regulatory guidance and requirements as they pertain to UR and site of service decisions
Possess a working knowledge of clinical documentation integrity, hospital billing and coding processes and guidelines, case mix index, and DRG assignments
Familiarity with standard published leveling criteria such as MCG/Interqual and ability to apply professional judgment and patient specific variables as may be necessary or justifiable
Familiarity with (Hospital) organization and case management operations
Excellent customer service and interpersonal skills
Able to effectively present information, both formal and informal
Superb written and verbal communications skills
Ability to set and manage priorities
Demonstrate flexibility, teamwork, and a collaborative leadership style
Strong technical/compute
MD Physician Advisor Preferred Qualifications
one (1) to five (5) years of experience in utilization review
inpatient clinical experience
About Us
We are Inova, Northern Virginia's leading nonprofit healthcare provider. Every day, our 26,000+ team members provide world‑class healthcare to the communities we serve. Our people are the reason we're a national leader in healthcare safety, quality and patient experience. And from best‑in‑class facilities to professional development opportunities, we support them at every step. At Inova, we're constantly striving to be ever better - to shape a more compassionate future for healthcare.
Inova Health System is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, pregnancy (including childbirth, pregnancy‑related conditions and lactation), race, religion, sex, sexual orientation, veteran status, genetic information, or any other characteristics protected by law.
To apply, visit https://elar.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_1/job/672755/?mode=location