Medical Director Care Coordination

About the role

Imagine yourself as a Medical Director Care Coordination at Banner Estrella Medical Center, where you'll play a pivotal role in optimizing patient care and resource utilization. At Banner Estrella, you'll be part of a dynamic care coordination team that completes over 60,000 reviews annually, ensuring patients receive the right care at the right time. You'll work alongside a multidisciplinary team dedicated to improving patient outcomes while navigating the complexities of utilization management in a supportive, collaborative environment. This position offers you the opportunity to leverage your clinical expertise in a leadership capacity, directly impacting both patient care quality and operational efficiency at one of Arizona's premier medical centers.

Responsibilities

• Conduct secondary medical necessity reviews and denial reviews, serving as a Physician Advisor who bridges clinical care with administrative requirements
• Conduct throughput and observation rounds
• Engage in professional peer-to-peer conversations with insurance company medical directors
• Have difficult but necessary conversations that protect both patients and the organization
• Work with the Dragonfly system to document your reviews
• Create presentations for stakeholders
• Mentor learners as part of our teaching environment
• Provide expertise via medical necessity reviews using current regulations, adopted guidelines, evidence based criteria and personal clinical experience, in order to assure optimal efficiency in the management of patient care
• Educate physicians, advanced practice professionals, administration, case management staff and the hospital health care community about managing the continuum of care for optimal utilization of resources
• Develop policies and programs that enhance the organization's management of care and resource utilization
• Actively participate in or lead care management activities to improve patient safety, provide patient-centered appropriate and timely care, implement evidence-based standards, enhance efficiency and throughput
• Participate in or initiate design and development of population-based guidelines or protocols for care based on findings and aggregate data review from the case management process to influence a plan of care for patients across the care continuum
• Collaborate with executive leadership to strategize and drive process improvements focused on innovative care delivery and/or operational models designed to improve clinical service outcomes, patient throughput, and patient safety
• Promote a patient-centered, healing environment
• Promote the use and implementation of technology in the workplace in order to maximize efficiency, streamline operations, facilitate communications, and optimize work processes
• Ensure and foster a high level of collaboration within a highly matrixed team environment in order to coordinate activities, review work, exchange information, and resolve problems
• Promote service excellence philosophies and learned best practices, at the facility and systemwide levels to enhance the overall patient experience
• Function as an integral member of the facility and system leadership teams
• Serve in an advisory capacity to applicable staff
• In collaboration with leadership team members, provide expertise regarding acute hospital care management and programs that meet system-wide organizational growth initiatives and the needs of patient populations in the community
• Along with other leadership team members, promote financial stewardship and clinical excellence for the facility regarding operational processes, with the goal of helping to ensure the efficient delivery of cost-effective services to patients, physicians, and hospital departments
• Advise medical and clinical teams to help them deliver appropriate clinical care to patients in the most appropriate setting
• Assist providers in appropriately documenting and communicating patient care plans to ensure excellent patient care
• Provide guidance, influence and promotion of appropriateness of physician practices regarding resource utilization
• Advise hospital processes to the use of community resources, particularly as they pertain to barriers to the continuum of care
• Work collaboratively with case management staff and other healthcare disciplines to plan for patients' care across the continuum
• Influence and contribute to systemwide process improvements
• Perform all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards
• Provide all customers of Banner Health with an excellent service experience by consistently demonstrating core and leader behaviors

Requirements

• Must possess a strong knowledge of the delivery of healthcare services as obtained with a degree as a Medical Doctor or Doctor of Osteopathy
• Requires current medical license and ideally Board Certification
• Must obtain Health Care Quality and Management Certification with Physician Advisor sub-specialty certification within 3 years of hire
• Must possess a knowledge and understanding of medical health maintenance organization (HMO) operations, NCHQ standards, hospital operations, reimbursement models, medical protocols and criteria, and peer review statutes as normally obtained through 5 years of medical practice experience
• Must possess a current knowledge of clinical protocols, CMS regulations, reimbursement challenges, and managed care principles
• Must possess excellent oral, written and interpersonal communication skills to effectively interact with all levels within the organization, as well as outside parties
• Excellent interpersonal skills with strong written and verbal communication skills
• Ability to present information in both formal and informal settings
• Organizational skills with ability to set priorities, demonstrate teamwork in the ever-changing health care environment
• Position requires proficiency in personal software applications, including word processing, generating spreadsheets, and creating graphics/presentations
• This on-site position at Banner Estrella Medical Center requires a Monday through Friday schedule from 8:00 AM to 4:30 PM
• Requires extensive sitting with periodic standing and walking
• May be required to lift up to 20 pounds
• Requires significant use of personal computer, phone and general office equipment
• Needs adequate visual acuity, ability to grasp and handle objects
• Needs ability to communicate effectively through reading, writing, and speaking in person or on telephone
• May require off-site travel
• Requires interstate and inter-facility travel for meetings and training

Qualifications

• Additional related education and/or experience preferred

Benefits

• Option to participate in a variety of health, financial, and security benefits
• This position may be eligible for our Management Incentive Program as part of your Total Rewards package

Schedule

• Monday through Friday, 8:00 AM to 4:30 PM
• Autonomy to volunteer for holiday coverage based on your preferences
• Comprehensive training (up to one month depending on your experience) to ensure your success in this specialized role

Supervisory responsibilities

• May include direct supervisory responsibility for a team of physician advisors
• If applicable, directs personnel actions including recruiting, new hire actions, interviewing and selection of new staff, salary determinations, training, and personnel evaluations