Physician Advisor, Utilization Management: Join Lexington Medical Center in Columbia, SC (Onsite)

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
• 24/7 Live Epic EMR Support from Our On-site Team
• Relocation Assistance and Sign On Bonus Opportunities
• Annual CME Allowance
• Malpractice Insurance (occurence-based) 
• 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. 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. Patient care and satisfaction is a focus, and scores are consistently ranked in the top 15% in the nation.

Exceptional Care, Where You Live

• 7,000+ health care professionals.
• 70 doctor's offices.
• 6 community medical and urgent care centers.
• Occupational health center.
• The largest extended care facility in the Carolinas.
• A specialized care center for Alzheimer's.

When Lexington County Hospital opened in 1971 as a nonprofit hospital, it quickly became a healthcare leader. More than 50 years later, we continue to serve our community as a local, independent, nonprofit hospital.

A History of Firsts

We were the first area hospital with satellite health facilities and established the first community health education department. We opened the state’s first satellite outpatient facility with services including surgery, urgent care, lab, radiology and physical therapy.

Growing to Meet Needs

By the 1980s, the now-called Lexington Medical Center offered community programs including education on managing disease and learning healthcare skills, such as newborn care and home nursing.

Community Medical Centers

In the 1990s, we established four community medical centers in small towns around Lexington County to provide residents with easier access to top-notch healthcare. In 2001, we opened our largest community medical center in Lexington. The center is larger than the hospital was in 1971.

Advanced Technology & Medical Firsts

Today, we are a modern medical complex. Our patients have access to advanced technology, leading-edge techniques.

Community-Based

Our mission is the same as it was when we opened our doors in 1971: to provide quality health services that meet the needs of our community. We believe that commitment to the health of our community really makes a difference — and we show it every day.

Community Highlights:

• Proximity to beautiful Lake Murray
• Affordable Cost of Living
• Annual average temperature is 68 degrees in December
• Lexington County is one of the fastest growing areas in South Carolina
• Family Friendly and 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.