Medical Director - Case Management & Utilization

Aoiassn; Town of Florida (NY); On-site; USD 250,000 - 400,000; Full time

Job summary

Aoiassn in Florida seeks a Medical Director of Case Management and Utilization Review to lead CM/UR activities and to serve as the hospital's primary physician advisor.

You will supervise other Physician Advisors, participate in UR committees, collaborate with leadership to improve patient flow and resource management, and provide physician education.

This senior role reports to the Senior Medical Director and requires Florida MD/DO licensure with extensive clinical and administrative experience.

Qualifications

• MD required or equivalent.
• Florida MD/DO licensure required.
• Graduate of AMA-approved medical school.
• Extensive clinical experience in multiple medical/surgical disciplines and administrative leadership in a large acute care hospital (5+ years).

Responsibilities

• Lead hospital-specific CM and UR activities.
• Serve as the primary physician advisor for the hospital and supervise other Physician Advisors.
• Act as a UR Committee member to identify opportunities to improve utilization and patient care quality.
• Assist Case Management staff in resolving patient care issues and educate physicians.
• Develop and promote resource management goals with hospital leadership and medical staff.
• Support enterprise CM/UR initiatives and participate in interdisciplinary rounds; provide feedback to physicians and care managers.
• Decide on pre-admission authorization, medical necessity, services/setting, admission appropriateness, and stay continuation for referred cases.
• Provide peer review for medical necessity of admission or continued stay; ensure alignment with standards of care.
• Liaise with Health Information Management and insurers for prior authorizations; help remove discharge barriers.
• Attend UR-related committees and contribute to UM/resource management initiatives including studies and data analysis for utilization and patient flow.
• Co-lead hospital UR activities and participate on system-level UR committees as applicable.

Education

Doctor of Medicine (MD)

Medical Doctor License (ME LICENSE) - State of Florida (FL)

Osteopathic Physician License (OS LICENSE) - State of Florida (FL)

Graduate of a medical school approved by the Council on Medical Education of the AMA

Job description

Aoiassn in Florida seeks a Medical Director of Case Management and Utilization Review to lead CM/UR activities and to serve as the hospital's primary physician advisor.

You will supervise other Physician Advisors, participate in UR committees, collaborate with leadership to improve patient flow and resource management, and provide physician education.

This senior role reports to the Senior Medical Director and requires Florida MD/DO licensure with extensive clinical and administrative experience.