SSM Health
Associate Vice President Care Coordination Liaison, Physician and Provider Advis
SSM Health, Saint Louis, Missouri, United States, 63146
It's more than a career, it's a calling.
MO-SSM Health Westview Building
Worker Type:
Regular
Job Summary:
This is NOT a remote position. This role will require relocation to the St. Louis, MO metro area upon acceptance of the position.
Job Highlights:
PRIMARY RESPONSIBILITIES
Collaborates with vendor partners to ensure appropriate balance of advocacy and support for patients, families, practitioners and professional staff and the organization.
Serves as the regional/ministry physician expert, providing medical direction and oversight to care management, utilization management and clinical documentation integrity (CDI) including length of stay management, complex care rounds, clinically and integrated networks.
Acts as primary contact for regional leadership with physician advisor services through oversight of vendor services to improve our appropriateness of 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 as well as the total operations for care progression for the organization.
Monitors metrics to drive performance improvement opportunities to achieve the highest quality and regulatory compliance through partnership with regional leaders and vendor.
Acts as escalation point for case prioritization with physicians and care management leaders for challenging, high conflict or outlier case circumstances.
Provides CDI medical oversight and follows up on individual peer to peer conversations regarding CDI queries.
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.
Actively participate in a leadership capacity in system and region governance for Care Transformation.
Oversees and is responsible for utilization management committee and governance for their respective region.
Accountable to the regional leadership team for denial management, medical necessity, and appropriate utilization of inpatient resources.
Recruits, engages, develops, leads, and manages assigned staff.
Performs other duties as assigned.
EDUCATION
Doctorate from an accredited school of medicine
EXPERIENCE
Seven years' experience, with two years in leadership
Department:
8745000033 Patient Experience
Work Shift:
Day Shift (United States of America)
Scheduled Weekly Hours:
40
BenefitsSSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs.
Paid Parental Leave : we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE).
Flexible Payment Options:
our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday.
Upfront Tuition Coverage:
we provide upfront tuition coverage through FlexPath Funded for eligible team members.
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.
To request additional information, confidentially submit your interest, or nominate a fellow colleague, please contact:
Angela Jones
Executive Talent Acquisition
Angela.Jones1@ssmhealth.com
#J-18808-Ljbffr
MO-SSM Health Westview Building
Worker Type:
Regular
Job Summary:
This is NOT a remote position. This role will require relocation to the St. Louis, MO metro area upon acceptance of the position.
Job Highlights:
PRIMARY RESPONSIBILITIES
Collaborates with vendor partners to ensure appropriate balance of advocacy and support for patients, families, practitioners and professional staff and the organization.
Serves as the regional/ministry physician expert, providing medical direction and oversight to care management, utilization management and clinical documentation integrity (CDI) including length of stay management, complex care rounds, clinically and integrated networks.
Acts as primary contact for regional leadership with physician advisor services through oversight of vendor services to improve our appropriateness of 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 as well as the total operations for care progression for the organization.
Monitors metrics to drive performance improvement opportunities to achieve the highest quality and regulatory compliance through partnership with regional leaders and vendor.
Acts as escalation point for case prioritization with physicians and care management leaders for challenging, high conflict or outlier case circumstances.
Provides CDI medical oversight and follows up on individual peer to peer conversations regarding CDI queries.
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.
Actively participate in a leadership capacity in system and region governance for Care Transformation.
Oversees and is responsible for utilization management committee and governance for their respective region.
Accountable to the regional leadership team for denial management, medical necessity, and appropriate utilization of inpatient resources.
Recruits, engages, develops, leads, and manages assigned staff.
Performs other duties as assigned.
EDUCATION
Doctorate from an accredited school of medicine
EXPERIENCE
Seven years' experience, with two years in leadership
Department:
8745000033 Patient Experience
Work Shift:
Day Shift (United States of America)
Scheduled Weekly Hours:
40
BenefitsSSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs.
Paid Parental Leave : we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE).
Flexible Payment Options:
our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday.
Upfront Tuition Coverage:
we provide upfront tuition coverage through FlexPath Funded for eligible team members.
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.
To request additional information, confidentially submit your interest, or nominate a fellow colleague, please contact:
Angela Jones
Executive Talent Acquisition
Angela.Jones1@ssmhealth.com
#J-18808-Ljbffr