Overview

The Medical Director - Care Management/Physician Advisor, the PHO Medical Director and Director of Care Management are the lead clinicians in partnership for managing the efficiency of care at the organization. The Medical Director CM/PA functions with or by the authorization of the Vice President of Medical Management. Conducts clinical review on cases referred by Care Management staff /Social Work/Utilization management and/or other health care professionals in accordance with the hospitals objectives for assuring quality patient care and effective, efficient utilization of heath care services appropriate level of care, monitoring the appropriate use of diagnostic and therapeutic modalities, and to meet regulatory requirements. Interacts with Medical Staff members, APP Medical Directors and Medical Directors of payers to discuss the needs of patients and alternative levels of care. Acts as consultant and resource to attending physicians regarding their decisions relative to appropriateness of hospitalization, continued stay and use of resources. Acts as consultant and resource to the Medical Staff regarding federal and state utilization and quality regulations.

Qualifications

• Graduate of an accredited medical school.
• Additional education in Quality and Utilization Management through continuing medical education. programs and self-study.
• Current Illinois license to practice medicine and eligibility for active membership on the hospital's medical staff.
• Minimum of 5 years recent experience in clinical practice.
• Utilization Management experience as a member of the UM oversight committee or past Physician Advisor experience preferred.
• Knowledge of National Medical Criteria

Accountabilities

1. Care Management
2. Utilization Management
3. Medical Oversight and Clinical Documentation Management
4. Collaboration/Physician Liaison