Recertification Manager Jobs in Modesto, CA (NOW HIRING)

Salary Range

$265,000 -$325,000 plus incentive opportunities = Annual Salary

Level

Executive Leadership

Position Type

Full Time Exempt

Job Shift

Day and may have some weekend on-call duty

Education Level

Doctor of Medicine Degree or Doctor of Osteopathic Medicine Degree

Company Information:

At Community Hospice & Health Services and its affiliates, Community Hospice & Health Services Foundation, and CHI Management, Inc. (herein referred to collectively as “CHHS”) you will find a family-based and compassionate work environment. Our goal is to provide wonderful work experiences that allow our employees to thrive by feeling engaged and fulfilled each day. CHHS is the largest and oldest nonprofit hospice, advanced care management (non-pharmacological palliative care), and support services provider in the Central Valley.

We are proud to share that CHHS has been supporting and providing compassionate and quality services to our community since 1979. Our mission is to embrace individuals and families facing life-changing journeys, enhancing quality of life for all. CHHS is accredited by Community Health Accreditation Partners (CHAP). We have been awarded “Best Places to Work in the Central Valley” several times.

Job Description:

SUMMARY:

The Medical Director is responsible for developing and managing all physician and nurse practitioner best practices to meet regulatory compliance requirements that meet or exceed high-quality standards of care, within the board approved budget. They manage Physician and NP/PA teams to meet revenue goals set for AMDs and NPs/PAs that result from patient services; (Hospice, Advanced Care Management, and other programs). The Medical Director actively engages with referring agencies and health care referral partners to meet or exceed census goals, raise brand awareness and increase market penetration.

RESPONSIBILITIES:

• Responsible for providing general management of medical care provided to assigned hospice patients, including clinical staff related to patient care and the functioning of the assigned interdisciplinary team, that meets or exceeds CMS quality standards.
• Provides supervision of Associate Medical Directors, Nurse Practitioners and Physician’s Assistants to achieve patient care within approved budgets. Completes an objective performance evaluation, with input from clinical management, for each Team member. 
• Oversee that medical documentation, certification and recertification are completed to industry standards using best practices and submitted to CHHS within set time frames; including CTIs, Death Certificates, and Patient Visit notes.
• Actively engage with Executive Committee on Patient Care (ECPC) in overall agency management and performance.
• Responsible to determine and certify and recertify (when appropriate), in conjunction with the attending physicians, patients’ eligibility for hospice care based upon confirmation of terminal diagnosis and six-month prognosis.
• Actively engage in setting and meeting quality goals through the QAPI process and in alignment with CMS regulations and Standards of Participation. Responsible for serving on such committees and projects to develop, implement, monitor, and improve the quality, efficiency, and effectiveness of hospice services.
• Lead and oversee effective IDT meetings to render the necessary medical management of the patient’s care related to the terminal illness.
• Responsible for the consultation with the patient’s primary care and/or attending physician regarding pain and symptom control or the plan of care.  Also responsible to issue prescriptions for medications as needed, including Schedule II drugs requiring triplicate orders.
• Assist in the development and review of clinical protocols, emergency care procedures and patient care policies in collaboration with Chief Clinical Officer and other clinical management. 
• Provide training and ongoing education for AMDs, PAs and NPs relevant to hospice care and participate in clinical staff training and development for ACHH and other clinical teams as required.
• In collaboration with the Business Development team build and maintain positive relationships with referral sources by conducting educational and informational forums to advance trust and credibility.
• Oversee physician care activities at Alexander Cohen Hospice House, including on-site visits to ensure optimal patient care.
• Determine the on-call/weekend schedules at least one month in advance and be available to provide on-call services in the event there is a need for on-call/weekend coverage.
• Be prepared to visit patients in their homes, inpatient hospitals, skilled nursing facilities, residential care facilities, and at the Alexander Cohen Hospice House as necessary. Performs or arranges for designees to perform palliative care consult visits in facilities or patient homes as needed.
• Attend Senior Leadership, Strategic Planning and Board meetings as requested to educate and report on medical services.
• Submit documentation and records to ensure full compliance and participation in audits and reviews to support CHHS.
• Work with Finance department to provide data to AMDs, PAs and NPs regarding coding, billing and patient care documentation monthly.
• Ensure all AMD, PA and NP licenses and certifications are clear and current along with required immunizations to perform their duties.
• Serves as an advocate and educator for CHHS and the hospice and palliative care industries in the communities where CHHS provides services.
• Ensure that all AMDs and other physician contracts are kept current and valid.
• Follows all Community Hospice policies and procedures including, but not limited to, safety, infection control, privacy and confidentiality, and HIPAA.

​​​​​​​Success Factors:

• Excellent written and oral communication skills, including the ability to communicate complex terms and abstract concepts to patients, their families, and hospice staff.
• Excellent interpersonal skills with patients, their families, hospice staff, community physicians, and other community medical providers.
• Ability to function as part of an interdisciplinary team with other professionals in medical, psychosocial, and spiritual care specialties.
• Ability to drive to hospice patients’ homes and to provide care for patients within their homes.
• Physical ability to read data visually from a CRT/VDT screen and to operate portable devices, a standard computer terminal, a standard multi-line, desktop telephone unit and a wireless telephone.

Minimum Qualifications:

• MD or DO with an active, unrestricted California license and holds primary certification in internal medicine or another specialty
• 2+ years of experience in hospice care
• Executive leadership management experience
• Knowledge of California-specific regulations and Medicare Conditions of Participation (CoPs).
• Board certified in hospice and palliative care from ABIM, AAHPM or HMDC, but eligible for future certification is acceptable.