At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience.
Summary:
The Utilization and Clinical Practice Advisor is a system-wide leader responsible for advancing the quality and consistency of clinical decision-making across utilization review and case management. This role designs, implements, and evaluates educational programs that promote compliance with medical necessity standards, improve physician documentation, reduce preventable denials, and enhance level of care accuracy. The Utilization and Clinical Practice Advisor serves as a subject matter expert, performance coach, and strategic partner to physician advisors, case management, and utilization teams, supporting organizational goals around length of stay, observation status optimization, and regulatory alignment.Responsibilities:
Provides input, prepares, monitors, and evaluates departmental budgets, and ensures that the department operates in compliance with allocated funding. Coordinates and directs internal and external audits. Oversees staffing activities including hiring, orienting, evaluating, disciplinary actions, and continuing education initiatives.Develops and implements educational and professional developmental goals, plans, and standards consistent with the clinical, administrative, legal, regulatory and ethical requirements and objectives of the organization.Facilitates clinical affiliation process and oversees the overall student educational experiences.Utilizes evidence-based practice research to identify strategies for improving staff development activities, clinical practice, and patient and family centered care outcomes.Collaborates with departments to assess learning needs and competency requirements. Plans and implements programs to enhance patient care delivery, information technologies, service level determination, complaint management, performance improvement or other educational needs of the organization. Oversees and coordinates onboarding and orientation plus mandatory educational offerings.Competencies:
COMMUNICATION SYSTEMS, CRISIS COMMUNICATION MANAGEMENT, DESKTOP SOFTWARE, HIPAA, INFORMED CONSENT AND ADVANCE DIRECTIVES, JOINT COMMISSION, KNOWLEDGE OF DISEASE PROCESS, MEDICAL TERMINOLOGY (1), PATIENT AND FAMILY CENTERED CARE, PATIENT RIGHTS, PATIENT SAFETY - ANCILLARY/SUPPORTEducation and Certification Requirements:
Masters (Required)Registered Nurse Compact License (RN LICENSE COMPACT) - Compact RN Multistate, Registered Nurse License (RN LICENSE) - State of Florida (FL)Additional Job Information:
Complexity of Work: This role operates with a high degree of autonomy and requires advanced clinical judgment, regulatory knowledge, and the ability to influence physician and interdisciplinary practice. Ability to interpret complex denial and utilization trends and translate them into effective education across clinical roles. Ability to navigate competing priorities, communicate effectively with executive stakeholders, and coach clinicians. Required Work Experience: Minimum of five (5) years within case management, utilization management, or a related area. Proven experience leading educational or performance improvement initiatives in a healthcare setting and demonstrated understanding of payer policies, CMS regulations, and level of care determination tools (e.g., InterQual, MCG). Other Information: Additional Education Info: Bachelors degree in Nursing or a health care related field is required. Master's degree preferred. A foreign trained physician with demonstrated experience in Utilization Management, Medical Necessity Education, Clinical Documentation, and discharge planning improvement may also be considered. A minimum of 5 years experience in these areas is required, including proven expertise in Utilization Management, Medical Necessity Education, Clinical Documentation, and discharge planning improvementAdditional License Info: Active, unrestricted RN license in the state of Florida or Foreign Medical Degree (MD or equivalent) may be considered in lieu of US licensure if the candidate has experience in utilization review, discharge planning and medical necessity documentation.Working Conditions and Physical Requirements:
Shift:
Disclaimer: This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification.
Wages shown on independent job boards reflect market averages, not specific to any employer. We encourage candidates to talk to their Memorial Healthcare System recruiter to discuss actual pay rates, during the hiring process.
Memorial Healthcare System is proud to be an equal opportunity employer committed to workplace diversity.
Memorial Healthcare System recruits, hires and promotes qualified candidates for employment opportunities without regard to race, color, age, religion, gender, gender identity or expression, sexual orientation, national origin, veteran status, disability, genetic information, or any factor prohibited by law.
We are proud to offer Veteran’s Preference to former military, reservists and military spouses (including widows and widowers). You must indicate your status on your application to take advantage of this program.
Employment is subject to post offer, pre-placement assessment, including drug testing.
If you need reasonable accommodation during the application process, please call 954-276-8340 (M-F, 8am-5pm) or email TalentAcquisitionCenter@mhs.net