Medical Director Care Coordination

Banner Health • Mesa, AZ

1d • Onsite

About The Position

The Medical Director Care Coordination serves as a physician executive responsible for appropriate and efficient medical management of cases while maintaining quality of care. The role provides individual-case and aggregate guidance, medical case review, utilization and quality review, and recommendations concerning quality and cost-effective care. It collaborates with hospital executive leadership, medical staff, resident physicians, nursing leadership, case management, and support staff to optimize length of stay, manage resources, improve documentation and coding, and ensure compliance with appropriate levels of care. The position also provides leadership and administration for medical management and contributes to the integration, coordination, and improvement of clinical care and patient safety for designated healthcare operations.

The role conducts secondary medical necessity and denial reviews, serves as a Physician Advisor, participates in throughput and observation rounds, and engages in peer-to-peer discussions with insurance company medical directors. It educates clinicians and operational teams about care management and resource utilization, contributes to policies and programs, and supports process improvements, patient safety, care coordination, and effective use of community resources. The role is non-clinical and does not provide direct patient care. It is an on-site position at Banner Baywood Medical Center in Mesa, Arizona, with a Monday-through-Friday schedule from 8:00 a.m. to 4:30 p.m. Holiday coverage may be volunteered for, and training of up to one month may be provided depending on experience.

Requirements

• Medical Doctor (MD) or Doctor of Osteopathy (DO) degree.
• Current medical license.
• Must obtain Health Care Quality and Management Certification with Physician Advisor subspecialty certification within three years of hire.
• Five years of medical practice experience, with knowledge of HMO operations, NCHQ standards, hospital operations, reimbursement models, medical protocols and criteria, and peer review statutes.
• Current knowledge of clinical protocols, CMS regulations, reimbursement challenges, and managed care principles.
• Excellent oral, written, and interpersonal communication skills, including the ability to interact effectively with internal and external parties and present information formally and informally.
• Organizational skills, ability to set priorities, and ability to work as a team in a changing healthcare environment.
• Proficiency with personal software applications, including word processing, spreadsheets, and graphics or presentation creation.

Nice To Haves

• Board certification is ideal.
• Additional related education and/or experience is preferred.

Responsibilities

• Conduct medical necessity reviews using current regulations, adopted guidelines, evidence-based criteria, and clinical experience.
• Conduct secondary medical necessity reviews and denial reviews, including documenting reviews in the Dragonfly system.
• Conduct throughput and observation rounds and participate in peer-to-peer conversations with insurance company medical directors.
• Educate physicians, advanced practice professionals, administration, case management staff, and the hospital community on care management and resource utilization.
• Develop policies and programs to improve care management and resource utilization.
• Lead or participate in care management activities that support patient safety, patient-centered and timely care, evidence-based standards, efficiency, and throughput.
• Develop or contribute to population-based guidelines and protocols informed by case management findings and aggregate data review.
• Collaborate with executive leadership on process improvements and care delivery or operational models that improve clinical outcomes, throughput, and patient safety.
• Promote technology use to improve efficiency, communication, and work processes.
• Collaborate across facility and system teams, exchange information, resolve problems, and promote service excellence and best practices.
• Advise staff and leadership on acute hospital care management and programs that support organizational growth and community patient needs.
• Promote financial stewardship and clinical excellence through efficient delivery of cost-effective services.
• Advise medical and clinical teams on appropriate care and care settings, documentation, patient care plans, resource utilization, and use of community resources.
• Work with case management and other healthcare disciplines to plan care across the continuum and contribute to systemwide process improvements.
• Create presentations for stakeholders and mentor learners in the teaching environment.

Benefits

• Option to participate in health, financial, and security benefits.
• May be eligible for the Management Incentive Program as part of the Total Rewards package.
• Training of up to one month, depending on experience.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Ph.D. or professional degree