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.

Qualifications

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

Competencies

• Excellent customer service and interpersonal skills.
• Able to effectively present information, both formal and informal.
• Strong written and verbal communications skills with all levels of internal and external customers.
• Strong analytical skills.
• Strong organizational skills and the ability to set priorities and multi-task.
• Demonstrated flexibility, teamwork, and accommodation to change in the healthcare environment.
• Ability to drive results and produce outcomes.

Additional Job Information

• Complexity of Work: Essential Competencies and Skills