Employed Providers Opportunities

SENIOR MEDICAL DIRECTOR OF CASE MANAGEMENT AND UTILIZATION REVIEW - FT DAYS - CORPORATE

• Location: Hollywood, FL
• Specialty: Case Management
• Job Number: FY25-37-10

The Senior Medical Director of Case Management and Utilization Review is a key leadership role in Case Management (CM) and Utilization Review (UR). This position oversees the functions of the Physician Advisor and Case Management Medical Directors at the hospital sites of care and reports to the VP, Chief Quality and Patient Safety Officer. In addition, this position provides primary support for Clinical Documentation Integrity (CDI) and serves as a liaison between CM, UR, and CDI teams and the medical staff. The Senior Medical Director provides strategy, clinical direction, and leadership to the organization, increasing its ability to produce best practice patient outcomes grounded in quality, legal, ethical, regulatory, and reimbursement parameters. Acts as the medical staff representative for the system-wide case management program and related activities. As an active member of the Memorial Healthcare System (MHS) Utilization Review Committee and in collaboration with it, identifies opportunities to improve utilization of hospital resources and the quality of patient care. Assists the Case Management leadership staff and hospital-based Physician Advisors and Medical Directors 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.

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Case Management: Supports the overall enterprise of the Case Management practice and ensures strategic planning for the teams at the sites. This includes, but not limited to: Length of stay management strategies; Readmission reduction strategies; Case Management escalation processes; Management and validation of a CM dashboard and associated data. Ensures the Physician Advisor, Medical Directors and CM practice are outcome oriented. Brings important matters in physician practices to the attention of the Medical Executive Committee, Department Chairs, the department, etc. Regularly attends medical staff meetings. Provides ongoing education related to the Conditions of Participation in Discharge Planning.Utilization Review:Oversees the system-wide Utilization Review Team. Manages and maintains compliance with UR Conditions of Participation, in partnership with the Vice President of CM-UR. Provides planned, sequenced ongoing education about payer and utilization matters, best clinical practice data and research, health care trends, collaborative initiatives and skills, post-acute continuum capabilities, changes in hospital policies and operations, and other salient subjects to physicians (on staff and private practice), physician assistants, nurse practitioners, medical students, and others. Serves as an expert resource to physicians and others regarding immediate or planned decisions when overt quality, ethical, regulatory, and/or financial risks may be incurred. As requested, serves as an expert clinical resource on development and utilization of established clinical guidelines, order sets, pathways, and other structured care methodologies. Assists physicians in improving the quality of documentation through system-wide education and information. Serves as a liaison between Health Information Management (HIM) Department and the medical staff.

Competencies:

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), Podiatric Physician License (PO LICENSE) - State of Florida (FL)

Additional Job Information:

Complexity of Work: Requires critical thinking skills, and decisive judgment. Must be able to work in a stressful environment. Must be able to work collaboratively with the medical staff as well as CM staff. Ability to educate and conduct presentations. Knowledge of JCAHO standards. Knowledge of FMQAI, PRO, AHCA, Utilization and Performance Improvement Activities. Skilled in informal and formal teaching methods. Excellent communication (verbal and written) skills for meetings, taskforces, negotiation, and individuals. Strong diplomacy and conflict resolution skills. Data and computer skills. Skilled in Medical Necessity Criteria application. Knowledgeable in laws and regulations regarding acute care standards, processes, and payments. Rapid cycle change or clinical performance improvement expertise.

Required Work Experience: Extensive experience in one or more branches of medicine or surgery; minimum of eight (8) post-training years of medical staff organization/administrative experience in a large acute care hospital.

Other Information: Additional Education Info: Doctoral degree (M.D. or D.O. or P.O.) from an accredited School of Medicine or College of Osteopathic Medicine.

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