Medical Director of Case Management and Utilization Review - FT Days ? MHM
Company: Memorial Healthcare System
Location: Hollywood
Posted on: March 24, 2026
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Job Description:
The Medical Director of Case Management and Utilization Review
leads the hospital specific execution of the Case Management (CM)
and Utilization Management (UR) and related activities. The Medical
Director functions as the primary physician advisor for the
hospital and supervises other Physician Advisors for that hospital.
As an active member of the UR 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 for referred
cases, provides physician education, and assists the hospital and
medical staff in developing and promoting resource management goals
and objectives. This position reports to the Senior Medical
Director of Case Management and Utilization Management. HeC-JG
Education and Clinical Documentation Improvement: Supports
education and clinical documentation improvement. This includes,
but not limited to: At least annually, educates and communicates to
the medical staff the role and benefits of case management. Assists
in conducting medical necessity education in collaboration with the
Senior Medical Director and Physician Advisors. Provides ad hoc
education and discussion regarding resource management cases with
physicians. Assists physicians in improving the quality of
documentation and serves as a liaison between Health Information
Management (HIM) Department and the medical staff. Complex Care
Management: Leads Complex Care Management. This includes, but not
limited to: Leads hospital initiatives to reduce complex patient
length of stay, in conjunction with nursing director of case
management. Leads hospital complex care meeting in collaboration
with case management leadership. Responds proactively to escalation
of care delays, particularly related to clinical care, physician
decision making, and patient and family related discharge barriers.
Works with physicians on efficient care of observation patients and
serves as liaison to insurance companies for prior authorizations
creating discharge delay. Case Management and Utilization Review:
Supports the overall enterprise of the Case Management and
Utilization Review. This includes, but not limited to: Makes
decisions on referred individual patient cases regarding
pre-admission authorization, medical necessity and
services/setting, appropriateness of admission, and continuation
stay. 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.
Supports the Senior Medical Director in Medical Staff Education.
Assists physicians in improving the quality of their medical
necessity documentation and works with MDs on efficient care of
observation patients. Serves as liaison to insurance companies for
prior authorizations and removes barriers to discharge. Supports
case management by attending interdisciplinary rounds (IDR) and
provides feedback and suggestions to physicians and CMs. Serves as
liaison to case management, social workers, nursing staff,
individual physicians, and the medical staff. Communicates with
Centralized UR staff and serves as support and back-up for case
management escalations during and outside of IDRs. Annual
Initiatives: Develops UM/resource management studies and projects
including fiscal data to improve utilization and patient flow in
collaboration with the URC and CM leadership. May include single
DRG studies and different physician practice patterns and
utilization; works with physicians to change practices and improve
outcomes. Utilization Review Committees: Co-leads hospital specific
UR Committee and is a member of the system UR Committee. Makes
decisions on referred individual patient cases regarding
pre-admission authorization, medical necessity and
services/setting, appropriateness of admission, and continuation of
stay. Competencies: Education and Certification Requirements:
Medical Doctor (Required)Medical Doctor License (ME LICENSE) -
State of Florida (FL), Osteopathic Physician License (OS LICENSE) -
State of Florida (FL) Additional Job Information: Complexity of
Work: Essential Competencies and Skills: Excellent customer service
and interpersonal skills. Able to effectively present information,
both formal and informal. Strong written and verbal communications
skills with all levels of internal and external customers. Strong
analytical skills. Strong organizational skills and the ability to
set priorities and multi-task. Demonstrated flexibility, teamwork,
and accommodation to change in the healthcare environment.? Ability
to drive results and produce outcomes. Required Work Experience:
Extensive experience in one or more branches of medicine or
surgery; at least, five (5) post-training years of medical staff
organization/administrative experience in a large acute care
hospital. Other Information: Additional Education Info: Graduate of
a medical school approved by the Council on Medical Education of
the American Medical Association. About Memorial Healthcare
System
Keywords: Memorial Healthcare System, Pompano Beach , Medical Director of Case Management and Utilization Review - FT Days ? MHM, Healthcare , Hollywood, Florida
