Position Purpose/Summary

• Purpose: Provides physician leadership and expertise related to care coordination, length of stay (LOS)/Ievel of care (LOC) management, care variation management, patient flow/throughput management, ancillary service utilization (e.g., lab and radiology) and clinical documentation improvement (COl)
• Policy-Setting Responsibilities: Responsible for reviewing and providing physician perspective for policies that relate to care coordination, care progression, patient access, care variation management and COl
• Decision-Making Authority: Responsible for collaborating with the care coordination, nursing, patient access, ancillary services and COl departments to meet established goals and for leading physician participation and compliance with responsibilities
• Supervisory Responsibility: Responsible for engaging physicians in care coordination, care progression, patient access, care variation management and COl activities

Applicant Skills/Background

1. Minimum Educational Training Required:

• Graduate of an accredited medical school
• Completion of specialty residency (e.g., Internal Medicine, Emergency Medicine)

2. Experience:

• Five years recent experience in clinical practice in a hospital strongly preferred
• Two years administrative background as physician manager preferred
• Previous experience as a physician advisor preferred
• Experience leading large-scale change efforts preferred
• Experience in academic medicine, if applicable

3. License, Registration or Certification Required :

• Board Certified/Eligible Physician licensed in the applicable states
• Certification by American Board of Quality Assurance
• Utilization Review Physicians (ABQAURP) preferred

4. Knowledge, Skills and Abilities:

• Strong clinical acumen
• Knowledge of case management principles, processes, and their practical application preferred
• Working knowledge of third-party payor guidelines/medical necessity criteria (e.g. , knowledge of admission criteria for all levels of care)
• Experience with denials management
• Knowledge of clinical, quality, and administrative facets of the healthcare industry
• Familiarity with clinical documentation requirements
• Working knowledge of Centers for Medicare and Medicaid Services rules and regulations, and interest in building this knowledge through experience and partnership with Case Management
• Excellent communication and presentation skills (both written and oral)
• Teaching and coaching skills
• Analytical ability and problem-solving skills
• Working knowledge of electronic medical record
• Knowledge of process improvement methodology