The Medical Director, Utilization Management, reports to the Vice President of Clinical Transformation and the Vice President of Revenue Cycle Management. Working with these Vice Presidents, the Academic Department Chairs (or their designees), and the leadership of the Medical Staff, this individual will provide clinical leadership and oversight of the Utilization Management function within the Department of Case Management. Utilization Management ensures appropriate utilization of resources, effective and accurate clinical documentation, and compliance with regulatory requirements. The Medical Director will support the work of the Utilization Management Clinical Documentation Improvement Specialists, HIM Coders, and Care Managers in the review and identification of resource management issues and/or quality of care concerns. The Medical Director will also work with members of the Medical Staff to resolve issues and ensure that the complexity of patients' conditions and medical decision making is properly documented within allowable standards. Finally, the Medical Director will support ongoing efforts in process improvement within Utilization Management as well as education of Medical Staff members to advance knowledge of best practices and resource stewardship.
The Medical Director, Utilization Management Physician Advisor (UM-PA) will hold responsibility for leading and supporting collaborative efforts focused on improving the value of health care throughout Cedars Sinai Medical Center and its Medical network. The UM-PA will work collaboratively with the UM department, medical staff, hospital leadership and various committees (including UM, Finance, CDI, IT) in a multidisciplinary fashion, to provide clinical perspectives in an effort to develop, organize, lead and promote processes for patients to receive medically necessary and high-quality care throughout their stay, and into their continuum of care. These processes will incorporate professional best practices and community standards of care, while assisting with reducing financial risks associated with denials.
This work will include a re-design of processes of care, implementation of clinical and operational improvements, clinical decision support, and other innovations. The goal is to ensure that Cedars-Sinai achieves internal clinical efficiencies to enhance operational performance—all while maintaining or improving the overall quality of care delivered.
Medical Degree (MD) from accredited medical school required.
Board Certified in Internal Medicine (or sub-specialty of same) required.
Member of good standing in Medical Staff at CSMC
Additional education in Quality and Utilization Management through formal programs or continuing medical education programs and self-study required
Candidates must have five (5) or more years of experience as a practicing physician and three (3) or more years of administrative experience improving a hospital/health system's efficiency, effectiveness, quality, and resource utilization (e.g., Utilization Management, Quality Improvement, etc.).
Candidate must have demonstrated expertise in EMR systems and Utilization Management software programs with strong analytical, quantitative and problem-solving skills.
Candidates must have an appreciation of the needs of full-time faculty physicians and physicians in private or group practice and have the flexibility to meet the needs of both groups.
Candidates must possess highly developed skills working effectively with a wide variety of stakeholders and constituencies who have strong interests and legitimate requirements.
Candidates will need to demonstrate a high level of personal confidence, presence and professional demeanor with the ability to build rapport with the Medical Staff and CSMC leadership and to manage through conflicting points of views with stake holder teams during times of change and ambiguity.
Demonstrated superior interpersonal, communication and presentation skills, in settings from one-on-one to large groups.
At Cedars-Sinai Medical Center we are proud of our diverse and inclusive work environment. We are committed to recruiting, selecting and retaining an engaged workforce from many backgrounds, perspectives and experiences at all levels of the organization, including age, gender identity, race, religion, gender, sexual orientation, physical or mental disability, military and/or veteran status or any other basis protected by federal and state law.
Internal Number: 123456
About Cedars Sinai Medical Center
Cedars-Sinai Medical Center is one of the largest and fastest-growing nonprofit academic medical centers in the U.S., with 886 licensed beds, 2,100 physicians, 2,800 nurses, and thousands of other healthcare professionals and staff. Clinical programs range from primary care for preventing, diagnosing, and treating common conditions to specialized treatments for rare, complex, and advanced illnesses. We are in a highly desirable location in the City of Los Angeles.