Medical Director Care Management - West Allis

Medical Director Care Management - West Allis

Job ID180012

Specialty / Department

Social Svcs And Cont Care

Full / Part TimeFull-Time

Hours / Bi-weekly Pay Period80

2020-09-01

Location + Aurora West Allis Med Ctr8901 W Lincoln AveWest Allis,WI53227

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Share + + + + How You'll Make a Difference

Manages efficiency of care at Advocate Aurora Health in partnership with Chief Medical Officer. Conducts clinical review of cases referred by health care professionals in accordance with hospital objectives for assuring quality patient care and effective, efficient utilization of heath care services appropriate level of care. Monitors appropriate use of diagnostic and therapeutic modalities and meets regulatory requirements. Interacts with Medical Staff members and Medical Directors of payers to discuss the needs of patients and alternative levels of care. Acts as consultant and resource to attending physicians regarding their decisions relative to appropriateness of hospitalization, continued stay, use of resources, and federal and state utilization and quality regulations.

+ Maintains accountability for achieving case management outcomes and supports medical staff in the clinical progression of patient care. Promotes efficient and appropriate use of health care resources across the continuum. Reviews outlier cases and recommends actions to expedite the appropriate outcomes.

+ Functions as Chair of Case Management/Utilization Committee. Contributes to development and achievement of organizational and committee goals. Provides input to assist in establishing committee and case management action plans.

+ Reviews cases, as appropriate, within 24 - 36 hours of admission, identifies potential for delay in care delivery that can impact transition to next lower level of care or extend LOS. Discusses case with UR/Care Management staff and/or attending physician, as needed.

+ Acts as clinical expert to provide facilitation of direct patient care and services for appropriate level of care options, duplicate and/or unnecessary testing, and discharge planning.

+ Provides support and education for medical staff on issues of documentation and coding. Serves as resource and champion for clinical documentation management and coding program at site as applicable.

+ Reviews cases that indicate a need for issuance of hospital notice of non-coverage. Acts as a liaison with payers to facilitate approvals and prevent denials. Assists with denial management process.

+ Provides education to physicians and other clinicians related to regulatory requirements, appropriate utilization, and alternative levels of care, community resources and end of life care. Collaborates with the medical staff and other health care professionals regarding the individual patient's plan of care and care goals within proposed / expected timelines and clinical pathways.

Qualifications

License & Certifications

Medicine and Surgery, MD-DO license issued by the state in which the team member practices, and

Physician board certification issued by an appropriate board recognized by the American Board of Medical Specialties or the American Osteopathic Association.

Education

Doctorate Degree in Medicine.

Experience

Typically requires 7 years of experience in utilization management and clinical practice.

Skills in diplomacy and negotiation in peer interactions regarding utilization issues.Basic computer skills. Strong analytical and decision making skills. Strong leadership and interpersonal skills. Ability to communicate effectively. Demonstrates knowledge of medical necessity criteria. Maintains current knowledge of federal, state and payer regulatory and contract requirements.

At Aurora Health Care

We're with you - it's not just our brand tagline. Leaders live our brand by creating a culture of passion, which touches every caregiver, every action and every thought. Imagine providing direction and focus that ensures we are putting the patient at the center of all we do. Passionate leaders live the Aurora values and act as role models for the entire organization - brand ambassadors in the truest form. Our leaders serve their communities, use the art of communication, and listen and understand the power of our purpose: We help each other live well. Our leaders instill a sense of significance in a diverse and inclusive workforce, and mobilize others to constantly find better ways to provide healthcare.

Aurora supports a safe, healthy and drug-free work environment through criminal background checks and pre-employment drug testing. We maintain a smoke-free environment at all our locations. We are an equal opportunity employer.