It's more than a career, it's a calling.
MO-SSM Health Mission Hill
Worker Type: Regular
Job Highlights:
PRIMARY RESPONSIBILITIES
- Oversees and manages the vendor relationship for physician advisement, ensuring appropriate balance of advocacy and support for patients, families, practitioners, professional staff and the organization.
- Serves as the physician expert and provides medical direction and oversight to care management, utilization management and clinical documentation integrity (CDI) including length of stay management, complex care rounds, clinically integrated networks, etc.
- Acts as primary contact for the organization’s leadership with physician advisor services, supports system and regional leadership through oversight of vendor services and internal expert/coach to improve our appropriateness of care progression. Ensures services support the regional unique factors affecting care delivery and care progression.
- Uses operational knowledge of Center for Medicare Services (CMS) guidelines and a keen understanding of the payor market and managed care contracts to monitor vendor service performance and total operations for care progression for the organization. Remains current on healthcare and payor regulatory provisions. Exhibits understanding of value-based care models, including perspective of care delivery focused on the right intervention, at the right time, and in the right care setting.
- Utilizes metrics to drive performance improvement opportunities to achieve the highest quality and regulatory compliance.
- Acts as escalation point for case prioritization with physicians and care management leaders for challenging, high conflict, or outlier case circumstances. Collaborates with stakeholders across the care continuum to ensure success throughout various stages of vendor relationship and care progression activities.
- Partners with vendor service, revenue cycle team, physicians, payors and care transformation leadership for education and communication to achieve desired outcomes.
- Develops effective and positive relationships with multiple stakeholders assuring successful implementation and maintenance including managing timelines, resources and deliverables.
- Demonstrates respect and values the contributions of all disciplines, building relationships that foster trust and confidence for all departments and teams involved with patient care.
- Participates in a leadership capacity in system and region governance for care transformation including serving as primary lead for the governance for utilization management.
- Recruits, engages, develops, leads, and manages assigned staff.
- Performs other duties as assigned.
EDUCATION
- Doctorate from an accredited school of medicine
EXPERIENCE
- Ten years' experience, with five years' in leadership
Job Summary:
This role is eligible for remote work in limited states. This role will drive strategy and operational effectiveness within the organization's structure through demonstrating operational effectiveness of care progression activities aligned with our value-based care strategy. Provides physician leadership and physician coaching for all activities of care management, utilization management, and clinical documentation integrity. Manages both strategically and operationally vendor partnerships, acting as a liaison and primary contact for organization’s physician advisor services. Supports strategic goals and drives behaviors to achieve meaningful and measurable outcomes. Acts as a system change agent to achieve programmatic goals, while leveraging resources and utilizing strengths within the organization and through partnerships to identify and addresses local and regional factors which affect care delivery. Collaborates with the clinical leaders, case management, clinical documentation integrity (CDI), and utilization management leadership to ensure quality and appropriate cost of care.
Department: 8745000033 Patient Experience
Work Shift: Day Shift (United States of America)
Scheduled Weekly Hours: 40
SSM Health is committed to equal employment opportunity based on race, color, religion, national origin, gender, sexual orientation, gender identity, pregnancy, age, physical or mental disability, veteran status, and all other statuses protected by law.
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