As an integral member of the hospital’s CM/UR department; I am involved in daily clinical documentation/medical record review for hospital admissions. As a physician advisor I work together with CM to follow CMS guidelines in accordance with quality standards as determined by the URC and Quality/Compliance Committee. Consult with staff regarding delegated UM and disease management operations under managed care contracts while meeting all regulator-contractual/accreditation requirements associated with these functions. Serve as a clinical resource and consultant to case managers and UR Department by reviewing medical records of patients identified by the CM/UR Department to: determine admission status certification, assist with level of care and length of stay management, assist with denial management, review and advise related to resource management, perform medical necessity reviews, and perform continued stay review.
We will review the reports from both physician advisor and employer to give the best decision. It will take 3-5 business days for reviewing after receiving two reports.