Primary City/State:
Phoenix, Arizona
Department Name:
Medical Necessity Review-Corp
Work Shift:
Day
Job Category:
Physicians
A rewarding career that fits your life. Those who have joined the Banner mission come from all walks of life, united by the common goal: Make health care easier, so life can be better. If changing health care for the
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.
In this Medical Director Care Coordination role, you'll utilize your clinical judgment and communication skills to make critical decisions that shape patient care pathways. You'll conduct secondary medical necessity reviews and denial reviews, serving as a Physician Advisor who bridges clinical care with administrative requirements. Your day will involve conducting throughput and observation rounds, engaging in professional peer-to-peer conversations with insurance company medical directors, and having difficult but necessary conversations that protect both patients and the organization. You'll work with the Dragonfly system to document your reviews, create presentations for stakeholders, and mentor learners as part of our teaching environment.
This on-site position at Banner Estrella Medical Center offers you a Monday through Friday schedule from 8:00 AM to 4:30 PM , providing you with work-life balance while allowing you to make a substantial impact on care delivery. You'll have the autonomy to volunteer for holiday coverage based on your preferences, and you'll receive comprehensive training (up to one month depending on your experience) to ensure your success in this specialized role.
Your pay and benefits are important components of your journey at Banner Health. This opportunity includes the option to participate in a variety of health, financial, and security benefits. In addition, this position may be eligible for our Management Incentive Program as part of your Total Rewards package.
Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of disciplines. Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you'll find many options for contributing to our award-winning patient care.
POSITION SUMMARY
This position acts as a physician executive to ensure the appropriate and efficient medical management of cases while assuring the quality of care is upheld as it relates to the primary and secondary review process. This position provides guidance on an individual case and aggregate level to cultivate efficiency related to patient care delivery. This position provides medical case review, utilization and quality review and provides recommendations, advice and liaison services concerning quality and cost-effective patient care. This position collaborates with hospital executive leadership, medical staff including resident physicians, nursing leadership and support staff. It works in conjunction with hospital executive leadership to optimize length of stay and efficiently manage resources. This position promotes improving documentation and coding and ensuring compliance with appropriate levels of care. This position has responsibility for providing leadership, direction, and administration of medical management, as well as the integration, coordination, and improvement of clinical care and patient safety for designated healthcare operations. Serves as a member of the facility executive leadership team for designated healthcare operations, building and supporting effective collegial relationships with stakeholders and ensuring optimal operating effectiveness and strategic positioning.
CORE FUNCTIONS
Provides 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.
Educates 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.
Develops policies and programs that enhance the organization's management of care and resource utilization.
Actively participates in or leads care management activities to improve patient safety, provide patient-centered appropriate and timely care, implement evidence-based standards, enhance efficiency and throughput. Participates in or initiates 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.
Collaborates 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. Promotes a patient-centered, healing environment. Promotes the use and implementation of technology in the workplace in order to maximize efficiency, streamline operations, facilitate communications, and optimize work processes.
Ensures and fosters a high level of collaboration within a highly matrixed team environment in order to coordinate activities, review work, exchange information, and resolve problems. Promotes service excellence philosophies and learned best practices, at the facility and systemwide levels to enhance the overall patient experience.
Functions as an integral member of the facility and system leadership teams. Serves in an advisory capacity to applicable staff. In collaboration with leadership team members, provides 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, promotes 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.
MDCCs advise medical and clinical teams to help them deliver appropriate clinical care to patients in the most appropriate setting. This expertise assists providers in appropriately documenting and communicating patient care plans to ensure excellent patient care. This non-clinical position does not deliver direct patient care. This position will provide guidance, influence and promotion of appropriateness of physician practices regarding resource utilization. In addition, this position advises hospital processes to the use of community resources, particularly as they pertain to barriers to the continuum of care. This position works collaboratively with case management staff and other healthcare disciplines to plan for patients' care across the continuum. In addition to impacting individual facilities, this role influences and contributes to systemwide process improvements. Internal customers include other physicians, executive leadership teams, department directors, and employees. External customers may include vendors, other physicians, and community members.
MINIMUM QUALIFICATIONS
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. Promotes coordination, communication and collaboration among all team members. 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.
PREFERRED QUALIFICATIONS
Additional related education and/or experience preferred.
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Our organization supports a drug-free work environment.
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EOE/Female/Minority/Disability/Veterans
Banner Health supports a drug-free work environment.
Banner Health complies with applicable federal and state laws and does not discriminate based on race, color, national origin, religion, sex, sexual orientation, gender identity or expression, age, or disability
