MEDICAL DIRECTOR OF CASE MANAGEMENT AND UTILIZATION REVIEW - FT DAYS – MHM

Responsibilities

• Supports education and clinical documentation improvement.
• Supports medical necessity education in collaboration with the Senior Medical Director and Physician Advisors.
• Provides ad hoc education and discussion regarding resource management cases with physicians.
• Aids physicians in improving the quality of their medical necessity documentation.
• Works with physicians on efficient care of observation patients and serves as liaison to insurance companies for prior authorizations creating discharge delay.
• Attends interdisciplinary rounds (IDR) and provides feedback and suggestions to physicians and CMs.
• Serves as liaison to case management, social workers, nursing staff, individual physicians, and the medical staff.
• Develops UM/resource management studies and projects including fiscal data to improve utilization and patient flow in collaboration with the URC and CM leadership.
• Makes decisions on referred individual patient cases regarding pre-admission authorization, medical necessity and services/setting, appropriateness of admission, and continuation of stay.
• Supports the Senior Medical Director in Medical Staff Education.
• Communicates with Centralized UR staff and serves as support and back-up for case management escalations during and outside of IDRs.

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.

Education and Certification Requirements

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

About Memorial Healthcare System

Memorial Healthcare System is one of the largest public healthcare systems in the United States. A national leader in quality care and patient satisfaction, Memorial has ranked 11 times since 2008 on nationally recognized lists of great places to work – in Modern Healthcare magazine, Florida Trend magazine and Becker’s Hospital Review, just to name a few.

Memorial’s facilities include its flagship, Memorial Regional Hospital, one of the largest in Florida; Memorial Regional Hospital South; Joe DiMaggio Children’s Hospital, the only freestanding children's hospital in Broward and Palm Beach counties; Memorial Hospital West; Memorial Hospital Miramar; Memorial Hospital Pembroke; and Memorial Manor, a US News five-star-rated nursing home.

Memorial’s work environment has been rated by employees and physicians alike as an open-door, inclusive culture that is committed to safety, transparency and, above all, outstanding service to patients and families.

About South Florida

South Florida offers a dynamic urban/suburban lifestyle with an abundance of cultural and recreational amenities, miles of beautiful beaches, top-rated golf courses, zoos and wildlife refuges, a vibrant arts community, museums and world-class dining. South Florida’s high quality of life – including year-round summer weather, exciting multiculturalism and no state income tax – attracts new residents from all over the country and around the world.