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
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
Graduate from an accredited school of medicine.
Licensure as a physician in Washington state.
Experience and success in leading and facilitating groups of
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
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.