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Memorial Healthcare System Logo Memorial Healthcare System · Health and Beauty

Medical Director of Case Management and Utilization Review

United States, Miramar · Job Posted May 05, 2026
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Job Description

The Medical Director of Case Management and Utilization Review leads the hospital specific execution of the Case Management (CM) and Utilization Management (UR) and related activities. The Medical Director functions as the primary physician advisor for the hospital and supervises other Physician Advisors for that hospital. As an active member of the UR Committee and in collaboration with it, identifies opportunities to improve utilization of hospital resources and the quality of patient care. Assists the Case Management staff in resolving patient care issues for referred cases, provides physician education, and assists the hospital and medical staff in developing and promoting resource management goals and objectives. This position reports to the Senior Medical Director of Case Management and Utilization Management.

Job Responsibility

  • Supports education and clinical documentation improvement
  • Leads Complex Care Management
  • Leads hospital initiatives to reduce complex patient length of stay
  • Makes decisions on referred individual patient cases regarding pre-admission authorization, medical necessity and services/setting, appropriateness of admission, and continuation stay
  • Provides peer review services for medical necessity of admission or continued stay
  • Supports the Senior Medical Director in Medical Staff Education
  • Assists physicians in improving the quality of their medical necessity documentation
  • Serves as liaison to insurance companies for prior authorizations and removes barriers to discharge
  • Supports case management by attending interdisciplinary rounds (IDR) and provides feedback and suggestions to physicians and CMs
  • Serves as liaison to case management, social workers, nursing staff, individual physicians, and the medical staff
  • Communicates with Centralized UR staff and serves as support and back-up for case management escalations
  • Develops UM/resource management studies and projects including fiscal data to improve utilization and patient flow
  • Co-leads hospital specific UR Committee and is a member of the system UR Committee

Requirements

  • Medical Doctor (Required)
  • Medical Doctor License (ME LICENSE) - State of Florida (FL)
  • Osteopathic Physician License (OS LICENSE) - State of Florida (FL)
  • Extensive experience in one or more branches of medicine or surgery
  • at least, five (5) post-training years of medical staff organization/administrative experience in a large acute care hospital
  • Graduate of a medical school approved by the Council on Medical Education of the American Medical Association
  • Excellent customer service and interpersonal skills
  • Able to effectively present information, both formal and informal
  • Strong written and verbal communications skills with all levels of internal and external customers
  • Strong analytical skills
  • Strong organizational skills and the ability to set priorities and multi-task
  • Demonstrated flexibility, teamwork, and accommodation to change in the healthcare environment
  • Ability to drive results and produce outcomes
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