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. Responsibilities include supporting education and clinical documentation improvement, leading complex care management initiatives to reduce complex patient length of stay, supporting overall enterprise of Case Management and Utilization Review including decisions on patient cases regarding pre-admission authorization, medical necessity, and services/setting appropriateness, providing peer review services, supporting medical staff education, serving as liaison to insurance companies and various hospital staff, developing utilization management/resource management studies and projects, and co-leading hospital specific Utilization Review Committees. The role requires a Medical Doctor license in Florida, extensive experience in medicine or surgery, and at least five years of post-training medical staff organization/administrative experience in a large acute care hospital. The position demands excellent customer service, communication, analytical, and organizational skills, and the ability to drive results and produce outcomes. Working conditions include various physical activities and exposure to biological and chemical hazards. Employment is subject to post offer, pre-placement assessment including drug testing.
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