Medical Director of Case Management and Utilization Review - FT Days - MHM

Overview The Medical Director of Case Management and Utilization Review leads the hospital-specific execution of Case Management (CM) and Utilization Management (UR) and related activities. The Medical Director functions as the primary physician advisor for the hospital and supervises other Physician Advisors for that hospital. As an active member of the UR Committee and in collaboration with it, identifies opportunities to improve utilization of hospital resources and the quality of patient care. Assists the Case Management staff in resolving patient care issues for referred cases, provides physician education, and assists the hospital and medical staff in developing and promoting resource management goals and objectives. This position reports to the Senior Medical Director of Case Management and Utilization Management. Responsibilities Lead the hospital-specific execution of Case Management (CM) and Utilization Management (UR) activities. Serve as the primary physician advisor for the hospital and supervise other Physician Advisors. Act as an active member of the UR Committee; collaborate to identify opportunities to improve utilization and patient care quality. Assist Case Management staff in resolving patient care issues for referred cases and provide physician education. Develop and promote resource management goals and objectives in collaboration with hospital leadership and medical staff. Support enterprise-wide CM/UR initiatives and participate in interdisciplinary rounds; provide feedback to physicians and care managers. Make decisions on referred individual patient cases regarding pre-admission authorization, medical necessity and services/setting, appropriateness of admission, and continuation of stay. Provide peer review for medical necessity of admission or continued stay and ensure alignment with professional standards for quality patient care. Serve as liaison to Health Information Management (HIM) and to insurance companies for prior authorizations; help remove discharge barriers. Attend and contribute to UR-related committees and engage in annual initiatives related to UM/resource management, including studies and data analysis to improve utilization and patient flow. Co-lead hospital UR activities and serve on system-level UR committees as applicable. Qualifications Medical Doctor (Required) Medical Doctor License (ME LICENSE) - State of Florida (FL) Osteopathic Physician License (OS LICENSE) - State of Florida (FL) Additional education: Graduate of a medical school approved by the Council on Medical Education of the American Medical Association. Extensive clinical experience in one or more medical/surgical disciplines and at least five (5) post-training years of medical staff organization/administrative experience in a large acute care hospital. #J-18808-Ljbffr Aoiassn