Medical Director of Quality and Utilization FT Days
Florida Hospital Waterman
Florida Hospital Waterman is a career destination for individuals who feel a calling to help fulfill our mission of providing whole-person care that is highly compassionate and clinically first-rate. Drawn by that mission, team members also appreciate our state-of-the-art hospital, which is strikingly situated on a lovely lakeside campus, approximately 1 hour Northwest of Orlando. In August 2003, the hospital opened the doors of this replacement facility on Hwy 441 in Tavares. The 450,000 square foot, 269-bed acute care facility offers the latest in medical technology. Each patient room is private, and the uniquely designed "clover leaf" patient care units consist of 60 beds per floor. The Emergency Department is sized to accommodate up to 60,000 visits per year.
Florida Hospital Waterman is committed to meeting our region's growing need for advanced comprehensive cardiac care. As part of that commitment, we are expanding our range of services to include interventional cardiology and open heart surgery services. At Florida Hospital Waterman, you'll enjoy a satisfying career and lifestyle as you help carry out our vital mission. We invite you to join our team!
- Reports directly to the Vice President/Chief Medical Officer and is responsible for operational management of Utilization Review and Quality. Responsible for obtaining and maintaining Utilization and Quality Metrics outcomes to meet AHS, National, and Waterman outcome goals.
- Provides input into the development of policies and procedures, and ensures all activities comply with hospital and outside regulatory agency standards.
- The Medical Director will serve the hospital through teaching, consulting and advising members of the Medical Staff, Care Management, Clinical Documentation Specialists, Quality Management, Health Information Services and the Hospital on matters regarding physician practice patterns, clinical performance measures and outcomes, documentation, appropriate utilization of resources along with medical necessity compliance.
- The Medical Director will work closely with the Chairman of the Medical Staff along with the Medical Staff Officers in areas of quality performance, utilization performance, and physician behavior.
- Consults and advises members of the Medical Staff, Care Management and Quality Management on hospital matters relating to physician practice patterns, clinical performance and outcomes, documentation. Regularly meets with specific providers and provider groups as needed for optimizing outcomes to established goals.
- Consults and advises members of the Medical Staff on excessive or inappropriate utilization of resources, medical necessity, compliance with regulations, and collaboration with payers and the community.
- Serves as chairperson for the hospitals’ Utilization Review Committee and is accountable for meeting financial and quality goals.
- Reviews avoidable delay information and works with interdisciplinary team to develop performance improvement initiatives.
- Serves as a consultant in hospital Quality and Efficiency meetings, such as, but not limited to, Patient Safety and Ethics, Mortality and Morbidity, and Observation Governance as directed by the CMO.
- Identification and participation in resource management strategies to successfully achieve length of stay (LOS) along with reduction in inappropriate use of hospital resources.
- Works with Insurance payers/CMS as indicated to monitor hospital denials and act as a resource for secondary review.
- Ensures physician support and execution for the Clinical Documentation Improvement (CDI) Program by promoting effective and efficient physician documentation to support the patient’s level of care and appropriateness of MS-DRG/DRG assignment.
- Demonstrate uncompromising ethics and personal integrity.
- Practice and support Standards of Behavior.
- Plan, organize, and control financial policies and processes.
- Develop and present operating and capital budgets, financial statements, and reports.
- Develop, implement and adhere to all FHW and AHS policies and procedures.
- Support and enable Corporate Compliance.
- Provide support to CMO in oversight of the Hospitalist/Intensivist Program/ Hospital based physician services, assisting with monitoring performance under the contracts.
- Orient new physicians to compliant documentation with on-going education of coding guidelines.
- Current Florida medical license to practice medicine required.
- Graduate from Medical School and residency program with additional education in Quality and Utilization Management via continuing education programs and self-study.
- Minimum 5 years recent clinical practice experience
- Management/Review Committee or service as physician advisor.
- Identification and commitment to mission, philosophy, and goals of organization.
- People skills including motivating, communicating, and conflict resolution.
- Highly advanced financial skills