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

Responsibilities

• Supports education and clinical documentation improvement.
• Supports the overall enterprise of the Case Management and Utilization Review.
• Leads Complex Care Management.
• Supports the Senior Medical Director in Medical Staff Education.
• Makes decisions on referred individual patient cases regarding pre-admission authorization, medical necessity and services/setting, appropriateness of admission, and continuation of stay.
• Supports case management by attending interdisciplinary rounds (IDR) and providing feedback and suggestions to physicians and CMs.
• Serves as liaison to case management, social workers, nursing staff, individual physicians, and the medical staff.
• Communicates with Centralized UR staff and serves as support and back-up for case management escalations during and outside of IDRs.
• Develops UM/resource management studies and projects including fiscal data to improve utilization and patient flow in collaboration with the URC and CM leadership.
• Co-leads hospital specific UR Committee and makes decisions on referred individual patient cases.

Requirements

• Medical Doctor (Required)
• Medical Doctor License (ME LICENSE) - State of Florida (FL)
• Osteopathic Physician License (OS LICENSE) - State of Florida (FL)

Qualifications

• Extensive experience in one or more branches of medicine or surgery.
• At least, five (5) post-training years of medical staff organization/administrative experience in a large acute care hospital.