Physician Advisor, Utilization Management: Join Lexington Medical Center in Columbia, SC (Onsite) - Lexington Medical Center

Join as our Physician Advisor & Medical Director of Utilization Management to join our dynamic healthcare organization to help shape the future of healthcare delivery through effective resource utilization, exceptional patient care, and evidence-based practices.

As the Medical Director of Utilization Management, you will play a vital role in ensuring effective and efficient utilization of hospital resources while maintaining high-quality medical care. This includes evaluation and development of processes and protocols to optimize length of hospital stay and efficient management of resources, championing best practices, ensuring patients are at the appropriate level of care, supporting documentation improvement initiatives, preventing payer denials, and promoting compliance with state and federal regulations. This is an excellent opportunity for a motivated and experienced individual with a strong clinical background and a passion for process improvement.

Position Highlights:

• Split schedule: 80% Administrative; 20% Hospitalist coverage
  • Hospitalist experience required
• Responsible for the quality, effectiveness, and efficiency of utilization management processes inclusive of:
  • Concurrent and retrospective medical necessity reviews
  • Oversight and education related to level of care management, length of stay management, and utilization of ancillary services
  • Analyze utilization patterns and recommend changes in hospital policies, procedures or practices as indicated by findings
  • Monitor and ensure compliance with internal policies and applicable standards and regulations.
  • Coordinate organizational efforts to reduce inappropriate admissions and readmissions
  • Collaborate with medical staff and leadership to support clinical documentation improvement efforts
  • Conduct Peer to peer reviews with payers to mitigate denials
  • Identify denial trends and work with the medical staff and hospital administration to implement processes to mitigate these.
  • Participate in medical staff meetings to champion utilization management initiatives
  • Chair of Utilization Management Committee

We are committed to offering quality, cost-effective benefits for our employees and their families. Competitive Day ONE Benefits:

• Medical, Dental, and Vision Insurance
• Retirement and Savings Plans
• 24/7 Live Epic EMR Support from Our On-site Team
• Relocation Assistance and Sign On Bonus Opportunities
• Annual CME Allowance
• Malpractice Insurance (occurence-based) 
• Life, Accidental, and Critical Illness Insurance
• Employer Paid Short- and Long-Term Disability (after 90 days)
• Healthcare FSA
• Daycare FSA
• 529 College Savings Plans
• Adoption Assistance
• Dependent Life Insurance
• On-site Child Care Center
• Public Service Loan Forgiveness (PSLF) Employer
• Health Directions Gym Membership
• Employee Discounts and Services