Medical Director Care Coordination

Banner Health•Phoenix, AZ

20h•Onsite

About The Position

This position acts as a physician executive to ensure the appropriate and efficient medical management of cases while assuring the quality of care is upheld as it relates to the primary and secondary review process. This position provides guidance on an individual case and aggregate level to cultivate efficiency related to patient care delivery. This position provides medical case review, utilization and quality review and provides recommendations, advice and liaison services concerning quality and cost-effective patient care. This position collaborates with hospital executive leadership, medical staff including resident physicians, nursing leadership and support staff. It works in conjunction with hospital executive leadership to optimize length of stay and efficiently manage resources. This position promotes improving documentation and coding and ensuring compliance with appropriate levels of care. This position has responsibility for providing leadership, direction, and administration of medical management, as well as the integration, coordination, and improvement of clinical care and patient safety for designated healthcare operations. Serves as a member of the facility executive leadership team for designated healthcare operations, building and supporting effective collegial relationships with stakeholders and ensuring optimal operating effectiveness and strategic positioning. As a Medical Director Care Coordination at Banner Estrella Medical Center, you'll play a pivotal role in optimizing patient care and resource utilization. You'll be part of a dynamic care coordination team that completes over 60,000 reviews annually, ensuring patients receive the right care at the right time. You'll work alongside a multidisciplinary team dedicated to improving patient outcomes while navigating the complexities of utilization management in a supportive, collaborative environment. This position offers you the opportunity to leverage your clinical expertise in a leadership capacity, directly impacting both patient care quality and operational efficiency at one of Arizona's premier medical centers. In this Medical Director Care Coordination role, you'll utilize your clinical judgment and communication skills to make critical decisions that shape patient care pathways. You'll conduct secondary medical necessity reviews and denial reviews, serving as a Physician Advisor who bridges clinical care with administrative requirements. Your day will involve conducting throughput and observation rounds, engaging in professional peer-to-peer conversations with insurance company medical directors, and having difficult but necessary conversations that protect both patients and the organization. You'll work with the Dragonfly system to document your reviews, create presentations for stakeholders, and mentor learners as part of our teaching environment. This non-clinical position does not deliver direct patient care. This position will provide guidance, influence and promotion of appropriateness of physician practices regarding resource utilization. In addition, this position advises hospital processes to the use of community resources, particularly as they pertain to barriers to the continuum of care. This position works collaboratively with case management staff and other healthcare disciplines to plan for patients’ care across the continuum. In addition to impacting individual facilities, this role influences and contributes to systemwide process improvements. Internal customers include other physicians, executive leadership teams, department directors, and employees. External customers may include vendors, other physicians, and community members.

Requirements

Must possess a strong knowledge of the delivery of healthcare services as obtained with a degree as a Medical Doctor or Doctor of Osteopathy.
Requires current medical license.
Must obtain Health Care Quality and Management Certification with Physician Advisor sub-specialty certification within 3 years of hire.
Must possess a knowledge and understanding of medical health maintenance organization (HMO) operations, NCHQ standards, hospital operations, reimbursement models, medical protocols and criteria, and peer review statutes as normally obtained through 5 years of medical practice experience.
Must possess a current knowledge of clinical protocols, CMS regulations, reimbursement challenges, and managed care principles.
Must possess excellent oral, written and interpersonal communication skills to effectively interact with all levels within the organization, as well as outside parties.
Excellent interpersonal skills with strong written and verbal communication skills.
Promotes coordination, communication and collaboration among all team members.
Ability to present information in both formal and informal settings.
Organizational skills with ability to set priorities, demonstrate teamwork in the ever-changing health care environment.
Position requires proficiency in personal software applications, including word processing, generating spreadsheets, and creating graphics/presentations.

Nice To Haves

Ideally Board Certification.
Additional related education and/or experience preferred.

Responsibilities

Provide expertise via medical necessity reviews using current regulations, adopted guidelines, evidence based criteria and personal clinical experience, in order to assure optimal efficiency in the management of patient care.
Educate physicians, advanced practice professionals, administration, case management staff and the hospital health care community about managing the continuum of care for optimal utilization of resources.
Develop policies and programs that enhance the organization’s management of care and resource utilization.
Actively participate in or lead care management activities to improve patient safety, provide patient-centered appropriate and timely care, implement evidence-based standards, enhance efficiency and throughput.
Participate in or initiate design and development of population-based guidelines or protocols for care based on findings and aggregate data review from the case management process to influence a plan of care for patients across the care continuum.
Collaborate with executive leadership to strategize and drive process improvements focused on innovative care delivery and/or operational models designed to improve clinical service outcomes, patient throughput, and patient safety.
Promote a patient-centered, healing environment.
Promote the use and implementation of technology in the workplace in order to maximize efficiency, streamline operations, facilitate communications, and optimize work processes.
Ensure and foster a high level of collaboration within a highly matrixed team environment in order to coordinate activities, review work, exchange information, and resolve problems.
Promote service excellence philosophies and learned best practices, at the facility and systemwide levels to enhance the overall patient experience.
Function as an integral member of the facility and system leadership teams.
Serve in an advisory capacity to applicable staff.
In collaboration with leadership team members, provide expertise regarding acute hospital care management and programs that meet system-wide organizational growth initiatives and the needs of patient populations in the community.
Along with other leadership team members, promote financial stewardship and clinical excellence for the facility regarding operational processes, with the goal of helping to ensure the efficient delivery of cost-effective services to patients, physicians, and hospital departments.
Advise medical and clinical teams to help them deliver appropriate clinical care to patients in the most appropriate setting.
Assist providers in appropriately documenting and communicating patient care plans to ensure excellent patient care.
Provide guidance, influence and promotion of appropriateness of physician practices regarding resource utilization.
Advise hospital processes to the use of community resources, particularly as they pertain to barriers to the continuum of care.
Work collaboratively with case management staff and other healthcare disciplines to plan for patients’ care across the continuum.
Influence and contribute to systemwide process improvements.
Conduct secondary medical necessity reviews and denial reviews.
Serve as a Physician Advisor who bridges clinical care with administrative requirements.
Conduct throughput and observation rounds.
Engage in professional peer-to-peer conversations with insurance company medical directors.
Have difficult but necessary conversations that protect both patients and the organization.
Document reviews using the Dragonfly system.
Create presentations for stakeholders.
Mentor learners as part of our teaching environment.

Benefits

Option to participate in a variety of health, financial, and security benefits.
May be eligible for our Management Incentive Program as part of your Total Rewards package.
Comprehensive benefit package for all benefit-eligible positions.

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