Medical Management Director jobs in South Carolina

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 the 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:

o M.D. or D.O. degree

o 5 years hospital based clinical practice experience in one of the following fields: internal medicine, family medicine, emergency medicine, or general surgery.

o 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.

o 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

About Lexington Medical Center

Lexington Medical Center is a 607-bed hospital in West Columbia, South Carolina. It anchors a health care network that includes six community medical centers and employs a staff of more than 7,800 health care professionals. The network includes a cardiovascular program recognized by the American College of Cardiology as South Carolina’s first HeartCARE Center. The network also has an occupational health center, the largest skilled nursing facility in the Carolinas, an Alzheimer’s care center and 70 physician practices. Lexington Medical Center operates one of the busiest Emergency departments in South Carolina, treating nearly 100,000 patients each year. The hospital delivers more than 4,000 babies each year and performs more than 25,000 surgeries.

We've been named Columbia's "Best Place to Have a Baby," "Best Hospital" and one of the "Top 25 Best Hospitals to Work for in the U.S.," honors all made possible by a dedicated, talented team of health care professionals and staff.

Exceptional Care, Where You Live

· 7,000 health care professionals.

· 75 doctor's offices.

· 6 community medical and urgent care centers.

· Occupational health center.

· The largest extended care facility in the Carolinas.

· A specialized care center for Alzheimer's.

When Lexington County Hospital opened in 1971 as a nonprofit hospital, it quickly became a healthcare leader. More than 50 years later, we continue to serve our community as a local, independent, nonprofit hospital.

A History of Firsts

We were the first area hospital with satellite health facilities and established the first community health education department. We opened the state’s first satellite outpatient facility with services including surgery, urgent care, lab, radiology and physical therapy.

Growing to Meet Needs

By the 1980s, the now-called Lexington Medical Center offered community programs including education on managing disease and learning healthcare skills, such as newborn care and home nursing.

Community Medical Centers

In the 1990s, we established four community medical centers in small towns around Lexington County to provide residents with easier access to top-notch healthcare. In 2001, we opened our largest community medical center in Lexington. The center is larger than the hospital was in 1971.

Advanced Technology & Medical Firsts

Today, we are a modern medical complex. Our patients have access to advanced technology, leading-edge techniques.

Community-Based

Our mission is the same as it was when we opened our doors in 1971: to provide quality health services that meet the needs of our community. We believe that commitment to the health of our community really makes a difference — and we show it every day.

Community Highlights:

· Close Proximity to beautiful Lake Murray

· Affordable Cost of Living

· Annual average temperature is 68 degrees in December

· Lexington County is one of the fastest growing areas in South Carolina

· Family Friendly and home to some of the best school districts in the state Located in the heart of South Carolina, Columbia offers an unexpected mix of tradition and tomorrow. Pairing a diverse food & drink scene with shopping, festivals and family friendly attractions; Columbia has something for everyone. On the banks of the Congaree River, Columbia boasts a wide variety of outdoor recreation activities, a premier international art museum, an award winning children's museum, a Zoo and Garden plus Division 1 Sports make Columbia, South Carolina an ideal place to live, work and play.

Job Type: Full-time

Benefits:

• 401(k)
• 403(b)
• 403(b) matching
• Dental insurance
• Employee discount
• Flexible schedule
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Loan forgiveness
• Paid time off
• Relocation assistance
• Vision insurance

Experience:

• hospital based clinical practice: 5 years (Required)
• utilization review and/or case management: 3 years (Required)

License/Certification:

• M.D. or D.O. license? (Required)
• ABQAURP Certification (Preferred)
• CHCQM-PHYAD Certification (Preferred)

Work Location: In person