About the Job
General Summary of Position
The System Medical Director is responsible for strategic oversight, program development, staff oversight, and performance management subject matter expertise metric development and implementation for physician advisor services across MedStar Health, while also remaining an active MedStar Health Physician Advisor. This position will lead a collaborative, standardized approach to the strategic development and implementation of MedStars physician advisor program.
The System Medical Director will be responsible for reviewing concurrent and retrospective cases referred by the Utilization or Case Management team and for assigning these reviews to other members of the Physician Advisor team. Collaborates and partners with physician case management and hospital leadership, finance, compliance, population health, and other pertinent stakeholders/committees to ensure an aligned approach to patient care with providing efficient quality care, discharge planning, and utilization review.
Primary Duties and Responsibilities
Provides strategic leadership and develops and implements short-and long-term strategies, policies, and best practices for the Physician Advisor Program across MedStar Health with an emphasis on a data-driven approach.
Oversees and implements daily Physician Advisor assignments and caseloads. Serves as a subject matter expert for escalations from Physician Advisors, medical staff, utilization review RNs, and case management leaders. Resolves cases where attending physicians are not cooperative regarding admission and discharge status/planning.
Operational oversight and implementation of standardized physician advisor coverage and practices for medical necessity reviews, secondary reviews, peer-to-peer discussion with payors, pre-bill denial interventions, in collaboration with UR/CM/RCM and medical staff denial, root cause determination, and upstream process improvement.
In collaboration with system ACM leaders and other key stakeholders, provides strategic direction and implementation of LOS and complex discharge management initiatives and best practices. Identify and address clinical over or underutilization trends, issues/barriers to discharge delays in service with specific clinical departments or other hospital-based processes.
Direct consultation and education for the ACM team, medical staff, and other key collaborators on regulatory requirements, appropriate utilization of hospital services, medical necessity documentation, denial management practices, and the goals/processes of MedStar Healths Acute Case Management and Physician Advisor Programs.
Strategic leadership to the optimization of the ACM platform in Cerner and emerging technologies to enhance real-time decision making, reduce administrative burden, and improve utilization review efficiency.
Promote hospital adherence to ensure compliance with CMS policies and updates regarding inpatient admissions, IPO list observation status, as well as the appropriateness of continued hospital stay. Maintains a working knowledge of criteria and coverage guidelines used in UM process, including Federal and State regulations.
Encourages a collaborative approach to patient care with the goal of providing efficient quality care, discharge planning, and utilization review. Collaborative approach to developing and implementing metrics at the department and individual level to drive and assess performance of the Physician Advisor Programs.
Oversight and management of physician advisor staffing schedules, workload distribution, and provider performance.
Educates and partners with physician and nursing leadership, finance, compliance, and population health, and other pertinent stakeholders/committees.
Minimal Qualifications
Education
Doctoral degree Board certified Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) required
Experience
10+ years in physician advisory and experience as a practitioner Knowledge of case management, utilization, physician advisory, and regulatory standards, and a working knowledge of denials, observation medicine, and length of stay management. Experience with MCG and Interqual criteria required
Licenses and Certifications
MD - Physician - State Licensure Licensed to practice medicine in the state of hospital location Upon Hire required Certification in healthcare administration/business, physician advisory, preferred or Physician Advisory ACPA-C or ABQUARP within 1 Year preferred
Knowledge, Skills, and Abilities
Excellent communication and presentation skills Strong interpersonal skills Leadership skills and demonstrates ability to lead teams and work effectively in a team matrixed environment Demonstrated ability to develop and implement strategic initiatives Proven ability to influence others, manage and resolve conflict, and collaborate effectively as necessary to execute goals Improvement mind-set focused on driving change using actionable data & lead change Independently solves complex problems related to utilization management, human resource issues, payer and managed care, and care coordination
Position Details
Hiring Range: USD $20.00 - USD $20.00 /Yr