Medical Director of Case Management and Utilization Review - FT Days - MHM
Core
Leads hospital execution of Case Management and Utilization Review, acting as the primary physician advisor to supervise Physician Advisors and manage complex patient care decisions.
Role type
Medical Director of Case Management and Utilization Review
Builds
Hospital resource management goals, patient flow improvements, and discharge efficiency initiatives
Domain
Healthcare administration / Utilization Management
Deliverable
client delivery
Required skills
Medical Doctor license, clinical decision-making, medical necessity assessment, peer review, interdisciplinary collaboration, data analysis for utilization studies
Preferred skills
Experience in medicine or surgery branches, administrative experience in large acute care hospitals
Technologies
Health Information Management systems, prior authorization platforms
Responsibilities
Educate medical staff on case management roles and medical necessity; lead complex care management initiatives to reduce length of stay; make decisions on pre-admission authorization and continuation of stay; serve as liaison to insurance companies for prior authorizations; co-lead Utilization Review Committees; develop utilization studies and projects to improve patient flow.
Seniority
Senior, hands-on IC with leadership responsibilities