Pediatric Utilization Review/Denial Management job in Pennsylvania. Position will: facilitate Hospital Observation Program, be responsible for and lead daily Observation Meetings; facilitate identification/reconciliation of Inpatient/ Observation and other level of care discrepancies with Medical staff; address questions and inquires from Patient Access, Audit Department and Utilization Management; facilitate patient throughput during hospital stay regarding ancillary testing/procedures ie - surgical procedures, Cardiology and Radiology studies; work collaboratively with Executive Health Resources regarding Medical Necessity Determinations and Denial management; participate in ALJ Administrative Law Judge Hearings and Medicaid telecons; submit timely written appeals to payers in response to denials related to Medical Necessity; participate in Managed Care Contract negotiations; serve as a resource to legal counsel for litigation issues dealing with medical necessity or breech of contract; lead Utilization Management Committee meetings; Participate in payer meetings and assist with payer contractual issues. Position also participates in Hospital RAC Program to mitigate denials and process appeals; Teaches Interns, Residents, Fellows, and attending physician new concepts and issue in Medicare Compliance and Documentation of Medical Necessity; and charts documentation in accord with Conditions of Participation. MD required, Pediatrician preferred; Must have experience with InterQual system; Insurance provider background a plus. If you are interested in this opportunity, please email physicians@staffpointe.com or fax to 1-877-878-1970 attn: Julie, and visit us online at www.staffpointe.com. Refer to Job# JK862N
