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Chiropractor - Clinical Reviewer
4 months ago
Summary
We are looking to hire 2 full-time, virtual, Chiropractor-Clinical Reviewer positions with the Physical Medical and Rehabilitation service to perform Utilization Review (UR).
Duties
The Richmond VA Medical Center, located in Richmond, Virginia, is a level 1a 349-bed facility offering primary, secondary, and tertiary health care in medicine, surgery, neurology, rehabilitation medicine, intermediate care, acute and sustaining spinal cord injury, skilled nursing home care, and palliative care. The medical center has four community-based outpatient clinics located in Charlottesville, Fredericksburg, Emporia and Spotsylvania County, Virginia, and a strong and mutually beneficial affiliation with the Medical College of Virginia. Residency programs exist in virtually all general and specialty areas of medicine, rehabilitation, surgery, psychiatry, and dentistry. The medical center has an active cardiac transplantation program.Chiropractors-Clinical Reviewers utilize comprehensive knowledge of neuromusculoskeletal practice and Utilization Review (UR) procedures to manage and triage internal/external facility and Community Care consults and referrals. The primary role is to ensure efficient coordination of care, assess appropriate level of care, and champion compliance of established Veterans Health Administration (VHA) and Standardized Episode of Care (SEOC) guidelines.
The duties and responsibilities of the Chiropractor-Clinical Reviewer include, but are not limited to the following: Utilization Review: Manages and triages internal, interfacility, and Community Care referrals and consults to ensure safe and efficient coordination of care for Physical Medicine and Rehabilitation PM&R services such as chiropractic, physical therapy, acupuncture, massage, etc. Utilizes comprehensive knowledge of neuromusculoskeletal clinical practice and Utilization Review (UR) principles to assess appropriate level of care and to ensure compliance with established Veterans Health Administration (VHA) and Standardized Episode of Care (SEOC) guidelines as outlined by VHA Office of Community Care. Monitors consults and Requests for Service (RFS) to prevent unnecessary treatment, duplication of services, and uncover opportunities to provide veterans with best-practice care. Conducts medical record reviews (internal/external) to evaluate medical necessity and timely care coordination of PM&R services, including but not limited to: imaging, labs, active problem list, pending consults, and other relevant information available in the veterans chart. Communicates with veterans via telephone, telehealth/VA Video Connect (VVC), or written response in cases where additional explanation of determination or PM&R physician response to clinical appeal or Patient Advocacy inquiry are necessary. Promotes excellence in customer service, internal/external by incorporating the VHA Core Values (integrity, commitment, advocacy, respect, excellence) into daily practice and performance. Coverage: Provides interfacility virtual consult coverage/triage for Community Care and PM&R consults for other Chiropractor Community Care Reviewer peers at participating VA facilities within VISN 6 and/or on the national level. Serves as a flex position, depending on the locality of the incumbent, providing both Utilization Review and chiropractic clinic coverage/direct patient services via face-to-face appointment or telehealth appointment in the absence of an onsite VA chiropractor (annual leave, sick leave, jury duty, FMLA, Administrative Responsibilities: Adheres to VHA Directives regarding the administration of chiropractic treatment to Veterans. Assists in the establishment of PM&R Standard Operating Procedures (SOPs) regarding Community Care referrals and management of Requests for Service (RFS). Serves as the liaison to Patient Advocacy, addressing appropriate clinical appeals process and facilitating contact with the Community Care team, working to resolve veteran concerns, complaints, and grievances related to Community Care. Contacts Community Care provider and veterans by telephone, written response, or telehealth visit as required. Monitors Community Care provider documentation to ensure evidence-based and patient centered-care. Provides advice and counsel or instruction to referring sources within and outside of PM&R regarding Community Care processes and on-going education to staff and referral sources as processes within Community Care evolve. Utilizes database management and reporting to analyze PM&R and Community Care service utilization trends and patterns. Collaborates with PM&R and Community Care staff to apply the data, information, and knowledge to develop improvements in SOPs, delivery of healthcare services, and patient outcomes. Work Schedule: Monday to Friday, 8:00 AM to 4:30 PM
Compressed/Flexible : It may be considered
Virtual : This is a virtual position.
Relocation/Recruitment Incentives : Not authorized
Permanent Change of Station (PCS) : Not authorized
Financial Disclosure Report: Not required
