The Regional Medical Director CC/DP and Utilization Review provides clinical and management leadership across multiple hospitals within the region. This role focuses on improving patient flow resource utilization and length of stay (LOS) strategic oversight. The Medical Director will report to the Vice President of Care Coordination Discharge Planning and Hospital Medicine and will collaborate closely with local hospital VPMAs and presidents. The Regional Medical Director will have direct reports including Physician Advisors at UPMC Presbyterian/ Shadyside Hospital.Key ResponsibilitiesLeadership & ManagementOversee Utilization Management (UM) across assigned hospitals ensuring alignment with UPMCs mission vision values and regulatory requirements.Lead and mentor Physician Advisors and other key medical staff leaders providing training and support to ensure consistent and effective UM practices. Foster strong partnerships with local hospital leadership including VPMAs and hospital presidents Director of CC/DPM hospitalists ED Directors CNOs and regional CNOs.Directly supervise and provide guidance to Physician Advisors at each hospital within the region.Clinical & Operational OversightUtilize measurable standards to monitor and improve the quality and costeffectiveness of patient care.Analyze utilization data to identify trends and implement strategies to enhance medical appropriateness LOS and reduce denials.Direct UM functions collaborating with CC/DP clinical teams and attending physicians to optimize care delivery and resource use.Communication & CollaborationServe as a liaison and consultant for internal UM functions promoting effective communication and problem resolution. Facilitate interactions between managed care organizations providers and payers to address benefit coverage utilization review and quality assurance.Promote adherence to URAC standards and regulatory requirements including CMS policies.Process ImprovementIdentify address and remove avoidable delays collaborating with CC/DPM clinical nursing and physicians to streamline care processes.Implement/adhere GMLOS goals using systemwide care plans order sets and discharge plans to ensure efficient evidencebased care.Documentation & Compliance**:Maintain clear and concise documentation of all physician advisory activities in the UPMC Care Management information system.Conduct or coordinate concurrent appeals for denied or downgraded coverage determinations by payers.Additional ResponsibilitiesPerform other duties as assigned adhering to systemwide competencies and behaviors.QualificationsStrong leadership and communication skills.Comfortable with difficult conversations.Partnership approach to work.Interprofessional focus on work and team building.Proven ability to collaborate effectively with hospital administration and clinical teams.Experience in utilization management and care coordination.Indepth understanding of regulatory requirements and standards.
Administrative -
