medical director, utilization review


   250, 000 : 280, 000 Our client is a world:
  class, Magnet, academic medical center and university hospital.
The 449:bed medical facility offers a full scope of acute:
   and general:
  care services, including a regional burn center, Level I Trauma Center, Neuropsychiatric Center, Level III neonatal care unit and a NCI designated comprehensive cancer center.
News and World Report has recognized the facility as one of Americas Best Hospitals for 15 consecutive years.
The Utilization Resource Medical Director (URMD) supports the utilization of resources, quality, clinical and fiscal goals of the medical center.
This physician works collaboratively with leadership and staff to facilitate utilization review, care coordination and progression, and discharge planning.
This physician will chair the Utilization Review Committee meetings.
The URMD reports jointly to the UCIMC Chief Medical Officer (for all matters of a clinical nature) and Chief Operating Officer (for all matters related to throughput and resource utilization).
The URMD will possess the following characteristics:
   Licensed physician in the State with no prior disciplinary action by any hospital, state or licensing board or the Centers for Medicare and Medicaid Services; Broad based clinical knowledge and understanding of utilization review and quality issues; Ability to demonstrate cost:
  efficient clinical practice; Respected by his/her peers; Established relationships within the Medical Staff, with commitment to education of peers and residents regarding utilization management activities; Demonstrated knowledge of State and Federal regulations as it pertains to utilization review activities to include severity of illness and intensity of service criteria; Knowledge of Emergency Medical Treatment and Active Labor act as it pertains to clinical practice; Understanding of managed care and governmental contracts and payment methodologies.
The primary functions of the URMD include:
   Providing input in the annual evaluation of the CM program; Review of cases for medical appropriateness and level of care; Intervention and education of physicians and residents as related to UM activities; Providing second level review for cases not meeting medical necessity criteria; Overseeing the review, modification and development of UM related policy and procedures; Direction of the Transfer Center:
   adjudicating transfers after screening by Transfer Center personnel, prior to contact with other UCI staff 7.
Liaison with insurance company Medical Directors as requested; 8.
Participating in formal review of long stay cases with the Case Management staff; 9.
Liaison between Case Management staff and the Medical Staff for cases that cannot be resolved at the Case Management level; 10.
Interaction with federal, state and county agencies to resolve issues as needed.