The Medical Director of Utilization Review is responsible for the medical oversight of activities related to appropriateness of Henry Ford Hospital (HFH) inpatient resources including appropriateness of admissions, patient statusing, utilization of hospital resources, and continued stays of inpatients. The Medical Director of utilization review will ensure the most efficient use of the institution's resources. This position reports to the Associate Chief Medical Officer for Henry Ford Hospital. Role includes:1.Medicare two midnight self-audits required to maintain compliance with appropriate DNB numbers2.Ensure correct patient status for hospitalized patients3.Chair Utilization Management Committee:a.Reviewing outlier data, observation LOSb.Set the schedule for department report outs4.Lead Complex Care Review meeting - review all patients admitted greater than 30 days5.Review daily observation/extended recovery report - discuss cases >24 hours with team as needed6.Work with central UM to ensure correct patient status (IP v OP)7.Attend daily progression rounds - daily as able on different units to assist with LOS initiatives and auditing8.Length of Stay (LOS) escalations; a.Respond to escalations from case management, RNs, residents, staff, etc.b.Work to facilitate studies, consults, authorizations occur in a timely manner9.Code 44s - UM committee physician concurrent statement. CMS Conditions of Participation10.Lead IPAS - scheduling, reviews, feedback11.Peer-to-peer casesa.Work with system UM medical director to streamline P2P casesb.Complete P2P for those payors that allow physician advisors to complete a P2P12.Educate physician and residents regarding UM process, updates, and LOS initiatives13.Ensure compliance with CMS Utilization Management Conditions of Participation (COP)14.Attend system IPAS monthly meetings15.Attending Length of Stay steering committee meetings16.Ensure completion of LOS/Cost outlier attestations17.Other duties as assignedMinimum Qualifications: EDUCATION/EXPERIENCE REQUIRED:
- Graduate of an accredited medical school and completion of a three year U.S. residency program and must be board certified in his/her specialty.
- Minimum of five (5) years practicing as a physician.
- Previous experience as Director of Utilization Review or Physician Advisor preferred.
CERTIFICATIONS/LICENSURES REQUIRED:
- Michigan Medical license
- Board certification in his/her specialty
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