Job Summary:    

• Collaborate closely with physicians, nurses, and other members of the care team to gather necessary clinical information and provide guidance on documentation.


• Support physician provision of patient care with accountability for designated patient case load.   


• Facilitate precertification and payor authorization processes and facilitate collaborative management of patient care across the continuum, intervening as necessary.    


• Conduct timely and thorough concurrent reviews of inpatient admissions to determine medical necessity and appropriateness of the level of care, using evidence-based criteria.


• Serve as a primary liaison between the hospital and third-party payers, submitting clinical reviews and securing authorizations for continued stays.


• Identify and escalate cases that do not meet criteria to the Physician Advisor for a secondary review and determination.


• Actively participate in daily multidisciplinary rounds to discuss patient progress, care plans, and barriers to discharge.


• Ensure that all review activities are documented accurately and comprehensively within the electronic health record (EHR) and case management systems.


• Assist in the collection and analysis of utilization data to identify trends and opportunities for process improvement within the hospital.


• Demonstrate and encourage team behavior and exceptional patient/guest experiences.      


• Uphold and promote patient safety and quality.