Senior Medical Director of Case Management and Utilization Review – FT Days – MHS

Job title:

Senior Medical Director of Case Management and Utilization Review – FT Days – MHS

Company

Memorial Healthcare System

Job description

Location: Hollywood, FloridaAt Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience.Summary: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.Responsibilities: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.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.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.Working Conditions and Physical Requirements:

• Bending and Stooping = 60%
• Climbing = 40%
• Keyboard Entry = 100%
• Kneeling = 40%
• Lifting/Carrying Patients 35 Pounds or Greater = 0%
• Lifting or Carrying 0 – 25 lbs Non-Patient = 60%
• Lifting or Carrying 2501 lbs – 75 lbs Non-Patient = 0%
• Lifting or Carrying

75 lbs Non-Patient = 0% * Pushing or Pulling 0 – 25 lbs Non-Patient = 60%

• Pushing or Pulling 26 – 75 lbs Non-Patient = 0%
• Pushing or Pulling

75 lbs Non-Patient = 0% * Reaching = 60%

• Repetitive Movement Foot/Leg = 40%
• Repetitive Movement Hand/Arm = 100%
• Running = 0%
• Sitting = 100%
• Squatting = 80%
• Standing = 80%
• Walking = 80%
• Audible Speech = 100%
• Hearing Acuity = 100%
• Smelling Acuity = 0%
• Taste Discrimination = 0%
• Depth Perception = 60%
• Distinguish Color = 60%
• Seeing – Far = 60%
• Seeing – Near = 60%
• Bio hazardous Waste = 40%
• Biological Hazards – Respiratory = 0%
• Biological Hazards – Skin or Ingestion = 0%
• Blood and/or Bodily Fluids = 40%
• Communicable Diseases and/or Pathogens = 0%
• Asbestos = 0%
• Cytotoxic Chemicals = 0%
• Dust = 0%
• Gas/Vapors/Fumes = 0%
• Hazardous Chemicals = 0%
• Hazardous Medication = 0%
• Latex = 0%
• Computer Monitor = 80%
• Domestic Animals = 40%
• Extreme Heat/Cold = 40%
• Fire Risk = 0%
• Hazardous Noise = 0%
• Heating Devices = 0%
• Hypoxia = 0%
• Laser/High Intensity Lights = 0%
• Magnetic Fields = 0%
• Moving Mechanical Parts = 0%
• Needles/Sharp Objects = 0%
• Potential Electric Shock = 0%
• Potential for Physical Assault = 40%
• Radiation = 0%
• Sudden Decompression During Flights = 0%
• Unprotected Heights = 0%
• Wet or Slippery Surfaces = 0%

Shift:Disclaimer: This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification.Wages shown on independent job boards reflect market averages, not specific to any employer. We encourage candidates to talk to their Memorial Healthcare System recruiter to discuss actual pay rates, during the hiring process.Memorial Healthcare System is proud to be an equal opportunity employer committed to workplace diversity.Memorial Healthcare System recruits, hires and promotes qualified candidates for employment opportunities without regard to race, color, age, religion, gender, gender identity or expression, sexual orientation, national origin, veteran status, disability, genetic information, or any factor prohibited by law.We are proud to offer Veteran’s Preference to former military, reservists and military spouses (including widows and widowers). You must indicate your status on your application to take advantage of this program.Employment is subject to post offer, pre-placement assessment, including drug testing.If you need reasonable accommodation during the application process, please call 954-276-8340 (M-F, 8am-5pm) or email

Expected salary

Location

USA

Job date

Sun, 08 Dec 2024 03:35:34 GMT

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