Physician Advisor, Utilization Management: Join Lexington Medical Center in Columbia, SC

Join us as our Physician Advisor (Medical Director) of Utilization Management and help shape the future of healthcare delivery through effective resource utilization, exceptional patient care, and evidence-based practices.

Lexington Medical Center is currently seeking a highly qualified and experienced Medical Director of Utilization Management to join our dynamic healthcare organization. As the Medical Director, you will play a vital role in ensuring effective and efficient utilization of hospital resources while maintaining high-quality medical care. This includes evaluation and development of processes and protocols to optimize length of hospital stay and efficient management of resources, ensuring patients are in the appropriate level of care, supporting documentation, coding improvements and compliance, and monitoring the appropriate use of diagnostic and therapeutic modalities. This is an excellent opportunity for a motivated individual with a strong background in utilization management and a passion for delivering exceptional healthcare services.

Why Join Us?

• Be a Leader in Optimizing Healthcare Resources: As our Medical Director of Utilization Management, you will play a pivotal role in championing best practices and evidence-based care, ensuring the efficient utilization of hospital resources. You will have the opportunity to drive positive outcomes, enhance patient experiences, and improve the overall quality of medical care.
• Make a Difference in Patient Care: By collaborating with our medical staff and Care Management team, you will guide the appropriate level of care and utilization of services for hospitalized patients, prevent denials, and promote compliance with state and federal regulations. Your expertise will directly impact patient outcomes and help shape the future of healthcare delivery.
• Engage in Collaborative and Innovative Practices: Join a vibrant interdisciplinary team that values collaboration, innovation, and continuous improvement. As an active member of our Process Improvement Committee and the chair of our UM Committee, you will contribute to policy development, identify utilization trends, and recommend actions to optimize resource utilization.
• Expand Your Knowledge and Influence: Our commitment to professional development means you'll have opportunities to enhance your skills and stay up to date with the latest healthcare advancements. You'll collaborate with medical review physicians, engage with third-party payers, and serve as a trusted resource for our medical staff, fostering a culture of learning and excellence.
• Work-Life Balance and Supportive Environment: We value the well-being and work-life balance of our employees. We offer competitive compensation, comprehensive benefits available day 1, and a supportive work environment that promotes collaboration, respect, and recognition of your contributions. Additional information on our benefits can be found below.

Standard Qualifications:

• Education and Training:
• M.D. or D.O. degree
• 5 years hospital based clinical practice experience in one of the following fields: internal medicine, family medicine, emergency medicine, or general surgery.
• 3 years experience with utilization review and/or case management in a managed care setting (payer or hospital).

• Certification, Licensure, Registration:

• Must possess Board certification by the American Board of Medical Specialties or the Bureau of Osteopathic Specialists .
• Preferred certifications include:
• Certification by the American Board of Quality Assurance and Utilization Review Physicians with a Physician Advisor subspecialty (ABQAURP).
• Certification in Health Care Quality and Management with a Physician Advisor subspecialty (CHCQM-PHYADV).

.Note: The performance metrics and additional information will be shared with selected candidates during the interview process to provide a comprehensive understanding.