Job Detail
Job Title:
Medical Director - Case Management - Regular Part-Time - DaysReq:
2025-0370Location:
HospitalDepartment:
Case ManagementSchedule:
Monday thru Friday, 3 out of 4 wks/per month
Job Description:
- PURPOSE OF JOB: The Medical Director, Case Management is a key member of the Doylestown Health leadership team and is charged with meeting the organizations goals and objectives for assuring the effective, efficient utilization of health care services. The Medical Director is a physician serving the hospital through teaching, consulting and advising the case management department and the hospital leadership. They shall develop expertise on matters regarding physician practice patterns, over and under-utilization of resources, medical necessity, levels of care, care progression, denial management, compliance with governmental and private payer regulations, appropriate physician coding and documentation requirements.
The Medical Director works closely with the medical staff leadership, the entire medical staff, all areas of resources management and case management to develop and implement methods to optimize use of hospital services for all patients while also ensuring the quality of care provided. This includes working with the hospital leadership to optimize length of hospital stay and efficient management of resources, insuring that patients are at the appropriate level of care, supporting documentation, coding improvements and compliance, and monitoring the appropriate use of diagnostic and therapeutic modalities.
- ESSENTIAL FUNCTIONS:
- Provides acute inpatient/observation services for the case management department.
- Provides physician education, collaboration and support related to regulatory requirements, appropriate utilization of hospital services, community resources, and alternate level of care..
- Provides organizational process improvement support for efforts requiring physician input and/or involvement.
- Provides clinical documentation improvement support by educating the medical staff on coding guidelines and clinical terminology to improve their understanding of severity, acuity, risk of mortality, and DRG assignments on their individual records.
Job Qualifications:
QUALIFICATIONS:
- Education:
- Holds and maintains an unrestricted medical license in the state of Pennsylvania.
- Board certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred.
- Experience: At least three years of practice in an acute care hospital. Experience in Utilization Management preferred.
- Other Skills:
- Possesses or acquires competence in the areas of utilization management, quality improvement and patient safety.
- Possesses a working knowledge of the Hospital organization and case management operations and administrative standards and policies.
- Strong computer skills and working knowledge of the hospital EHR.
- Competence with Interqual and Milliman criteria.
- Member of the American College of Physician Advisors (ACPA) preferred.
- Ability to build rapport wth the medical staff and hospital leadership to obtain the buy-in and collaboration necessary to achieve outcomes.