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:
Medicare two midnight self-audits required to maintain compliance with appropriate DNB numbers
Ensure correct patient status for hospitalized patients
Chair Utilization Management Committee:
a. Reviewing outlier data, observation LOS
b. Set the schedule for department report outs
Lead Complex Care Review meeting - review all patients admitted greater than 30 days
Review daily observation/extended recovery report - discuss cases >24 hours with team as needed
Work with central UM to ensure correct patient status (IP v OP)
Attend daily progression rounds - daily as able on different units to assist with LOS initiatives and auditing
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 manner
Code 44s - UM committee physician concurrent statement. CMS Conditions of Participation
Lead IPAS - scheduling, reviews, feedback
Peer-to-peer cases
a. Work with system UM medical director to streamline P2P cases
b. Complete P2P for those payors that allow physician advisors to complete a P2P
Educate physician and residents regarding UM process, updates, and LOS initiatives
Ensure compliance with CMS Utilization Management Conditions of Participation (COP)
Attend system IPAS monthly meetings
Attending Length of Stay steering committee meetings
Ensure completion of LOS/Cost outlier attestations
Other duties as assigned
Minimum 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:
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Additional Information
Organization: Henry Ford Hospital - Detroit Main Campus
Department: Administration - Hospital
Shift: Day Job
Union Code: Not Applicable
Additional Details
This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.
Overview
Henry Ford Health partners with millions of people on their health journey, across Michigan and around the world. We offer a full continuum of services - from primary and preventative care to complex and specialty care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye care and other health care retail. With former Ascension southeast Michigan and Flint region locations now part of our team, Henry Ford's care is available in 13 hospitals and hundreds of ambulatory care locations. Based in Detroit, Henry Ford is one of the nation's most respected academic medical centers and is leading the Future of Health: Detroit, a $3 billion investment anchored by a reimagined Henry Ford academic healthcare campus. Learn more at henryford.com/careers .
Benefits
The health and overall well-being of our team members is our priority. That's why we offer support in the various components of our team's well-being: physical, emotional, social, financial and spiritual. Our Total Rewards program includes competitive health plan options, with three consumer-driven health plans (CDHPs), a PPO plan and an HMO plan. Our team members enjoy a number of additional benefits, ranging from dental and eye care coverage to tuition assistance, family forming benefits, discounts to dozens of businesses and more. Employees classified as contingent status are not eligible for benefits.
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health is committed to the hiring, advancement and fair treatment of all individuals without regard to race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height, weight, marital status, family status, gender identity, sexual orientation, and genetic information, or any other protected status in accordance with applicable federal and state laws.
