Memorial Healthcare System is hiring: Medical Director of Case Management and Ut

The Medical Director of Case Management and Utilization Review leads the hospital specific execution of the 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. HeC-JG Education and Clinical Documentation Improvement: Supports education and clinical documentation improvement. This includes, but not limited to: At least annually, educates and communicates to the medical staff the role and benefits of case management. Assists in conducting 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. Assists physicians in improving the quality of documentation and serves as a liaison between Health Information Management (HIM) Department and the medical staff. Complex Care Management: Leads Complex Care Management. This includes, but not limited to: Leads hospital initiatives to reduce complex patient length of stay, in conjunction with nursing director of case management. Leads hospital complex care meeting in collaboration with case management leadership. Responds proactively to escalation of care delays, particularly related to clinical care, physician decision making, and patient and family related discharge barriers. Works with physicians on efficient care of observation patients and serves as liaison to insurance companies for prior authorizations creating discharge delay. Case Management and Utilization Review: Supports the overall enterprise of the Case Management and Utilization Review. This includes, but not limited to: Makes decisions on referred individual patient cases regarding pre-admission authorization, medical necessity and services/setting, appropriateness of admission, and continuation stay. Provides peer review services for medical necessity of admission or continued stay, conformance to professional standards for quality patient care, and for other cases referred by CE staff. Supports the Senior Medical Director in Medical Staff Education. Assists physicians in improving the quality of their medical necessity documentation and works with MDs on efficient care of observation patients. Serves as liaison to insurance companies for prior authorizations and removes barriers to discharge. Supports case management by attending 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. Communicates with Centralized UR staff and serves as support and back-up for case management escalations during and outside of IDRs. Annual Initiatives: Develops UM/resource management studies and projects including fiscal data to improve utilization and patient flow in collaboration with the URC and CM leadership. May include single DRG studies and different physician practice patterns and utilization; works with physicians to change practices and improve outcomes. Utilization Review Committees: Co-leads hospital specific UR Committee and is a member of the system UR Committee. Makes decisions on referred individual patient cases regarding pre-admission authorization, medical necessity and services/setting, appropriateness of admission, and continuation of stay. 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) Additional Job Information: Complexity of Work: Essential Competencies and Skills: 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. Required Work Experience: 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. Other Information: Additional Education Info: Graduate of a medical school approved by the Council on Medical Education of the American Medical Association. About Memorial Healthcare System

In Summary: The Medical Director of Case Management and Utilization Review leads the hospital specific execution of the Case Management . HeC-JG Education and Clinical Documentation Improvement: Supports education and clinical documentation improvement . Leads hospital initiatives to reduce complex patient length of stay, in conjunction with nursing director of case management .

En Español: El Director Médico de Gestión y Utilización Revisión lidera la ejecución específica del hospital para el manejo de casos (CM) y gestión de uso (UR) y las actividades relacionadas. El director médico actúa como asesor médico primario para el hospital y supervisa a otros consejeros médicos para ese hospital. Como miembro activo del Comité UR y en colaboración con él, identifica oportunidades para mejorar la utilización de los recursos hospitalarios y la calidad de la atención al paciente. Asiste al personal de administración de casos en la resolución de problemas de cuidado de pacientes para los casos referidos, proporciona al médico, y ayuda al equipo médico en el desarrollo y promoción de objetivos y metas de gestión de recursos médicos. Esta posición informa al director médico senior de gestión y gestión del caso. Gestión de Cuidados Complejos: lidera la gestión compleja del cuidado. Esto incluye, pero no se limita a: Lidera iniciativas hospitalarias para reducir la duración compleja de la estancia del paciente, junto con el director de enfermería de administración de casos. Lidera una reunión de atención del hospital complejo en colaboración con el liderazgo de gestión de caso. Responderá proactivamente a la escalada de retrasos en los cuidados, particularmente relacionados con la atención clínica, la toma de decisiones médicos y las barreras relacionadas con la alta del paciente y la familia. Trabaja con los médicos sobre el cuidado eficiente de pacientes de observación y provee como vínculo con las compañías de seguros para obtener autorizaciones preliminares que crean retraso en la baja. Apoya la gestión de casos asistiendo a rondas interdisciplinarias (IDR) y proporciona retroalimentación y sugerencias a médicos y CM en colaboración con el URC. Puede incluir estudios individuales de DRG y diferentes patrones de práctica médica y utilización; trabaja con los médicos para cambiar las prácticas y mejorar los resultados. Comités de Revisión de Utilización: Co-líder del Comité Especial de Competencias Hospitalarias de Florida y es miembro del Comité de Educación del Sistema. Toma decisiones sobre casos individuales relacionados con la preautorización formal, las competencias médicas necesarias y los servicios oficiales de licencia/licenciamiento médico y cumplimiento). Habilidades de comunicación escrita y verbal fuertes con todos los niveles de clientes internos y externos. Fuertes habilidades analíticas. Fortes habilidades organizativas y la capacidad para establecer prioridades y múltiples tareas. Demostrada flexibilidad, trabajo en equipo y adaptación al cambio en el entorno sanitario.? Capacidad para impulsar resultados y producir resultados. Experiencia laboral requerida: amplia experiencia en una o más ramas de medicina o cirugía; por lo menos cinco (5) años post-entrenamiento de organización del personal médico/experiencia administrativa en un gran hospital de cuidados agudos. Otra información: Información adicional: Graduado de una escuela médica aprobada por el Consejo sobre Educación Médica de la Asociación Médica Americana. Sobre Memorial Healthcare System