Medical Director - Case Management - Memorial Healthcare System
Pembroke Pines, FL
About the Job
Location:
Pembroke Pines, Florida
At 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 Medical Director of Case Management is the key medical staff representative for the hospital Case Management (CM) program and related activities. As an active member of the 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 staff in resolving patient care issues by performing peer review for referred cases, provides physician education, and assists the hospital and medical staff in developing and promoting Resource Management goals and objectives.
Responsibilities:
Develops, with medical staff involvement, criteria, which screen for appropriate use of ancillary services, specialty units, or other targeted areas.Serves as a liaison to the medical staff for Case Management activities. Promotes and encourages medical staff involvement in such activities. Educates and communicates to the medical staff the benefits/need for CM. Discusses resource management problem cases with attending physicians, offering explanations and suggestions. Assists physicians in improving the quality of documentation. Encourages physicians to participate in appropriate discharge planning.Conducts and/or participates in weekly complex care rounds to address issues with complex care patient population to mitigate excessive hospital stays.Serves as a liaison between Health Information Management Department and the Medical Staff in regard to Data Quality and Data Base Optimization.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.Assists Medical Staff Chair to the Utilization Review Committee.Develops collaborative relationships with Attending Physicians and front-line providers to foster understanding of case management regulations, workflow and facilitate better throughput.In collaboration with the administration and using valid fiscal data, suggests UM/Resource Management studies to evaluate the cost effectiveness of various treatment practices, especially those prescribed by different physicians for patients within the same DRG. Based on study results, works with physicians to modify practice changes while promoting positive outcomes.Conducts interdisciplinary rounds regularly. Communicates with Centralized UR staff as needed.Makes decisions on referred individual patient cases regarding; Pre-admission authorization, medical necessity and services/setting, appropriateness of admission, and of continued stay.Serves as the link between CM and the medical staff by providing ongoing education about the rules of reimbursement and CMS Conditions of Participation.
Competencies:
Education and Certification Requirements:
Medical Doctor (Required)Medical Doctor License (ME LICENSE) - State of Florida (FL)
Additional Job Information:
Complexity of Work: 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.Required Work Experience: Extensive experience in one or more branches of medicine or surgery; at least five years of medical staff organization/administrative experience in a large acute care hospital. Required Work Experience: Extensive experience in one or more branches of medicine or surgery; at least five years of medical staff organization/administrative experience in a large acute care hospital. Other Information: Essential Competencies and Skills• Excellent customer service and interpersonal skills.• Able to effectively present information, both formal and informal.• Strong analytical skills.• Strong written and verbal communications skills with all levels of internal and external customers.• Strong organizational skills and ability to set priorities and multi-task, demonstrates flexibility, teamwork, and is accustomed to change in the healthcare environment.• Demonstrates ability to drive results and produce outcomes.Additional Education Info: Graduate of a medical school approved by the Council on Medical Education of the American Medical Association.
Working Conditions and Physical Requirements:
Pembroke Pines, Florida
At 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 Medical Director of Case Management is the key medical staff representative for the hospital Case Management (CM) program and related activities. As an active member of the 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 staff in resolving patient care issues by performing peer review for referred cases, provides physician education, and assists the hospital and medical staff in developing and promoting Resource Management goals and objectives.
Responsibilities:
Develops, with medical staff involvement, criteria, which screen for appropriate use of ancillary services, specialty units, or other targeted areas.Serves as a liaison to the medical staff for Case Management activities. Promotes and encourages medical staff involvement in such activities. Educates and communicates to the medical staff the benefits/need for CM. Discusses resource management problem cases with attending physicians, offering explanations and suggestions. Assists physicians in improving the quality of documentation. Encourages physicians to participate in appropriate discharge planning.Conducts and/or participates in weekly complex care rounds to address issues with complex care patient population to mitigate excessive hospital stays.Serves as a liaison between Health Information Management Department and the Medical Staff in regard to Data Quality and Data Base Optimization.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.Assists Medical Staff Chair to the Utilization Review Committee.Develops collaborative relationships with Attending Physicians and front-line providers to foster understanding of case management regulations, workflow and facilitate better throughput.In collaboration with the administration and using valid fiscal data, suggests UM/Resource Management studies to evaluate the cost effectiveness of various treatment practices, especially those prescribed by different physicians for patients within the same DRG. Based on study results, works with physicians to modify practice changes while promoting positive outcomes.Conducts interdisciplinary rounds regularly. Communicates with Centralized UR staff as needed.Makes decisions on referred individual patient cases regarding; Pre-admission authorization, medical necessity and services/setting, appropriateness of admission, and of continued stay.Serves as the link between CM and the medical staff by providing ongoing education about the rules of reimbursement and CMS Conditions of Participation.
Competencies:
Education and Certification Requirements:
Medical Doctor (Required)Medical Doctor License (ME LICENSE) - State of Florida (FL)
Additional Job Information:
Complexity of Work: 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.Required Work Experience: Extensive experience in one or more branches of medicine or surgery; at least five years of medical staff organization/administrative experience in a large acute care hospital. Required Work Experience: Extensive experience in one or more branches of medicine or surgery; at least five years of medical staff organization/administrative experience in a large acute care hospital. Other Information: Essential Competencies and Skills• Excellent customer service and interpersonal skills.• Able to effectively present information, both formal and informal.• Strong analytical skills.• Strong written and verbal communications skills with all levels of internal and external customers.• Strong organizational skills and ability to set priorities and multi-task, demonstrates flexibility, teamwork, and is accustomed to change in the healthcare environment.• Demonstrates ability to drive results and produce outcomes.Additional Education Info: Graduate of a medical school approved by the Council on Medical Education of the American Medical Association.
Working Conditions and Physical Requirements:
- Bendi
Source : Memorial Healthcare System