Join as our Physician Advisor & Medical Director of Utilization Management to join our dynamic healthcare organization to help shape the future of healthcare delivery through effective resource utilization, exceptional patient care, and evidence-based practices.



As the Medical Director of Utilization Management, 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 length of hospital stay and efficient management of resources, championing best practices, ensuring patients are at the appropriate level of care, supporting documentation improvement initiatives, preventing payer denials, and promoting compliance with state and federal regulations. This is an excellent opportunity for a motivated and experienced individual with a strong clinical background and a passion for process improvement.



Position Highlights:

• Split schedule: 80% Administrative; 20% Hospitalist coverage
  • Hospitalist experience required
• Responsible for the quality, effectiveness, and efficiency of utilization management processes inclusive of:
  • Concurrent and retrospective medical necessity reviews
  • Oversight and education related to level of care management, length of stay management, and utilization of ancillary services
  • Analyze utilization patterns and recommend changes in hospital policies, procedures or practices as indicated by findings
  • Monitor and ensure compliance with internal policies and applicable standards and regulations.
  • Coordinate organizational efforts to reduce inappropriate admissions and readmissions
  • Collaborate with medical staff and leadership to support clinical documentation improvement efforts
  • Conduct Peer to peer reviews with payers to mitigate denials
  • Identify denial trends and work with the medical staff and hospital administration to implement processes to mitigate these.
  • Participate in medical staff meetings to champion utilization management initiatives
  • Chair of Utilization Management Committee

We are committed to offering quality, cost-effective benefits for our employees and their families. Competitive Day ONE Benefits:

• Medical, Dental, and Vision Insurance
• Retirement and Savings Plans with No Vesting Period
• 24/7 Live Epic EMR Support from Our On-site Team
• Relocation Assistance and Sign On Bonus Opportunities
• Annual CME Allowance
• Tail Coverage for Medical Malpractice
• Life, Accidental, and Critical Illness Insurance
• Employer Paid Short- and Long-Term Disability (after 90 days)
• Healthcare FSA
• Daycare FSA
• 529 College Savings Plans
• Adoption Assistance
• Dependent Life Insurance
• On-site Child Care Center
• Public Service Loan Forgiveness (PSLF) Employer
• Health Directions Gym Membership
• Employee Discounts and Services

Lexington Medical Center is a 607-bed teaching 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 8,500 health care professionals. The hospital is ranked best hospital in the Columbia Metro and #2 hospital in South Carolina by U.S. News & World Report and was named one of the "Best Places to Work in South Carolina" by SC Biz News, in partnership with the South Carolina Chamber of Commerce and Best Companies Group. Lexington Medical Cancer Center is an accredited Cancer Center of Excellence and has a clinical research and education affiliation with MUSC Hollings Cancer Center. 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 more than 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. Its postgraduate medical education programs include family medicine and transitional year residencies.



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.



Community Highlights:

• Within Driving Distance to 7 Major Airports
• Close proximity to beautiful Lake Murray
• Safe, family friendly community
• Reasonable Cost of Living
• Central Location, easy access to mountains and beaches
• Located on the banks of the Congaree and Saluda Rivers, outdoor activities plentiful
• 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.



Please visit our facility websites  Show Contact Details  and  Show Contact Details  to learn more about Lexington Medical Center.