Medical Director Job In Miami, Florida
Regional Director of Utilization Management, Up to $250,000 Base
This job was posted 3 days ago. Be one of the first 5 applicants.
Are you looking for a move away from clinical medicine? Does the idea of living and working in South East Florida sound great to you?
If so, please give me a call to discuss our new opportunity for a Regional Director of Utilization Management!
The Regional Director of Utilization Management will do clinical medical necessity reviews for our affiliate and employed clinician practices. The RDUM is accountable for orientation, training, coaching and mentoring the Medical Directors. They serve as a physician advisor to the utilization management and care coordination nursing department responsible for clinical process. They are accountable for monitoring market clinical metrics and giving guidance to the Utilization Management clinical team for improvement.
Provide physician review services for utilization management, quality management, and conduct peer to peer reviews
· Develop, maintain and assure compliance with physician review policies and procedures (including timeliness) for utilization management and support case management.
· Support collaborative relationships with physicians, large provider groups, hospitals, other facilities and ancillary providers.
· Work closely with market medical directors to assure members are at the right level of care
· Identify potentially unnecessary services and care delivery settings, and recommend alternatives if appropriate by analyzing clinical protocols.
· Examine clinical programs information to identify members for specific case management and/or disease management activities or interventions by utilizing established screening criteria.
· Conduct medical necessity reviews for acute and post-acute initial admission reviews, DME, Home Health continued stay, Skilled Nursing continued stay reviews and post-discharge and discharge planning with clinical staff and peers
· Lead Clinical Round Discussion and educate nursing staff on specific conditions and disease processes
· Support the roll out of clinical initiatives in the local markets through work with the local market physician teams and care coaches
· Excellent written and verbal communication skills. Demonstrate active listening skills; communicate clearly and concisely; ensure understanding regardless of the communication vehicle; understand the needs and perspectives of others with ability to tailor the delivery accordingly; share information appropriately
· Emotional Maturity as demonstrated by an understanding of oneself to manage emotions; listen to and understand others; able to build trusting relationships with patients, providers, and care team; understand proper use of chain of command and know when and how to escalate.
· Ability to work independently under general instruction but also understands how to collaborate with a team of all levels
· Attention to detail with ability to work in a fast paced environment to meet regulatory time frames
· Responsible for achieving organization goals and metrics; accountable for results of assignment; take accountability for results
· Strong organization and time management skills with the ability to prioritize; organize and manage multiple priorities and/or projects using appropriate methodologies and tools
· Demonstrated ability to create a positive and meaningful patient, provider and care team experience
· Self –motivated and committed to achieving results
· Possess critical thinking skills, independent decision making capability
· Proactively identify, evaluate, and solve problems with logic and a systematic approach; look beyond the obvious to see root cause issues and creative solutions. Make appropriate decision in the face of ambiguity. Anticipate and resolve barriers and constraints
· Flexible to changes in assignments and teams
· A current and unrestricted Florida medical license and willing to obtain license, as required, for various states in region of assignment
· MD or DO degree
· Board Certified in an approved ABMS Medical Specialty
· Five years clinical patient facing experience – post residency
· Excellent communication skills
· Technical ability with Microsoft Applications and other computer based programs
· Experience working with and/or directing clinical nursing personnel
Preferred Education, Experience & Skills
· Health Plan experience
· Previous Medicare Advantage/Medicare/Medicaid experience
· Previous experience leading teams focusing on utilization management, discharge planning and/or home health or rehab
· Medical management experience, working with managed care clinics, health insurance organizations, hospitals and other healthcare providers, patient interaction, etc.
· Process-oriented, evidence-based and scientifically-inclined, consistent, enjoys being a part of a team, thoughtful and has a thirst for continuous education and development
· Additional Education: BSN or Bachelor’s degree in a related field
· Previous experience in utilization management within managed care industry
· Strong working knowledge of Excel
· Previous experience in Front End Review, SNF, LTAC, DME or Home Health
· This role reports to the VP in the Utilization Management Department under the leadership of the Care Delivery Organization Shared Service Vice President.