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Medical Director - Utilization Review

Company: PeaceHealth
Location: Bellingham
Posted on: September 12, 2020

Job Description:

Medical Director - Utilization Review -Bellingham, WA

Are you an MD looking for your next role in exercising influence in change management?

PeaceHealth is seeking a Medical Director of Utilization Review  to work in a Dyad role with Care Management. The Medical Director will act as a liaison between the CDI professional, HIM, and the hospital’s medical staff to facilitate accurate and complete documentation for coding and abstracting of clinical data, capture of severity, acuity and risk of mortality, in addition to DRG assignment.

OUR MEDICAL DIRECTOR WILL:

Co-Chair the Utilization Management Committee ans serve as second level reviewer for UM, providing guidance on appropriate/alternative levels of care based on InterQual guidelines and other appropriate criteria.

conduct clinical reviews on cases referred by care management staff to meet regulatory requirements and in accordance with the hospitals’ objectives for assuring quality patient care and effective, efficient utilization of health care services.

meet with care management and health care team members to discuss selected cases and make recommendations for care, interacting with medical staff members and medical directors of third-party payers to discuss the needs of patients and alternative levels of care.

act as consultant to and resource for attending physicians regarding their decisions relative to appropriateness of hospitalization, continued stay, and use of resources.

foster effective working relationships among the parties and facilitate resolution to problems. May conduct periodic team meetings with physicians, nurses, support staff and applicable hospital personnel, and implement such other communication methods as are necessary.

perform additional job functions as deemed appropriate and warranted.

QUALIFICATIONS:

Graduate from an accredited school of medicine.

Licensure as a physician in Washington state.

Experience and success in leading and facilitating groups of physicians.

Two years utilization management experience as a member of the UM Committee or past physician advisor experience preferred.

PHYSICAL & COGNITIVE REQUIREMENTS:

Work requires fairly light physical exertion up to 33% of the time, with the ability to lift objects weighing 50 lbs. or less.

For full consideration of your skills and abilities, please attach a current resume with your application. EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state, or federal laws.

Keywords: PeaceHealth, Bellingham , Medical Director - Utilization Review, Other , Bellingham, Washington

Click here to apply!

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