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MO-SSM Health Westview Building

Worker Type:

Regular

Job Highlights:

PRIMARY RESPONSIBILITIESCollaborates with vendor partners to ensure appropriate balance of advocacy and support for patients, families, practitioners and professional staff and the organization.Serves as the regional/ministry physician expert, providing medical direction and oversight to care management, utilization management and clinical documentation integrity (CDI) including length of stay management, complex care rounds, clinically and integrated networks.Acts as primary contact for regional leadership with physician advisor services through oversight of vendor services to improve our appropriateness of care progression. Ensures services support the regional and/or ministry unique factors affecting care delivery and care progression.Uses operational knowledge of Center for Medicare Services (CMS) guidelines and a keen understanding of the payor market and managed care contracts to monitor vendor service performance as well as the total operations for care progression for the organization. Remains current on healthcare and payor regulatory provisions. Exhibits understanding of value-based care models, including perspective of care delivery focused on the right intervention, at the right time, and in the right care setting.Monitors metrics to drive performance improvement opportunities to achieve the highest quality and regulatory compliance through partnership with regional leaders and vendor.Acts as escalation point for case prioritization with physicians and care management leaders for challenging, high conflict or outlier case circumstances. Collaborates with stakeholders across the care continuum to ensure success throughout various stages of vendor relationship and care progression activities.Provides CDI medical oversight and follows up on individual peer to peer conversations regarding CDI queries.Partners with vendor service, revenue cycle team, physicians, payors and Care Transformation leadership for education and communication to achieve desired outcomes.Develops effective and positive relationships with multiple stakeholders assuring successful implementation and maintenance including managing timelines, resources, and deliverables.Demonstrates respect and values the contributions of all disciplines, building relationships that foster trust and confidence for all departments and teams involved with patient care.Actively participate in a leadership capacity in system and region governance for Care Transformation including serving as primary lead for the governance for Utilization Management.Oversees and is responsible for utilization management committee and governance for their respective region.Accountable to the regional leadership team for denial management, medical necessity, and appropriate utilization of inpatient resources including providing strategic and operational guidance/partnership to the regional leadership team on these issues.Recruits, engages, develops, leads, and manages assigned staff.​Performs other duties as assigned.

EDUCATION

Doctorate from an accredited school of medicine  

EXPERIENCE

Seven years' experience, with two years in leadership

Named 150 Top Places to Work in Healthcare 2023 - Becker's Healthcare

Named One of America's Greatest Workplaces for Diversity 2023 - Newsweek

Named One of America's Greatest Workplaces for Women 2023 - Newsweek

SSM Health is a Catholic, not-for-profit health system serving the comprehensive health needs of communities across the Midwest through a robust and fully integrated health care delivery system. The organization’s 40,000 team members and more than 12,800 providers are committed to providing exceptional health care services and revealing God’s healing presence to everyone they serve.
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With care delivery sites in Illinois, Missouri, Oklahoma and Wisconsin, SSM Health includes 23 hospitals, more than 300 physician offices and other outpatient and virtual care services, 13 post-acute facilities, comprehensive home care and hospice services, a pharmacy benefit company, a health insurance company and an accountable care organization. It is one of the largest employers in every community it serves.

To request additional information, confidentially submit your interest, or nominate a fellow colleague, please contact:

Angela Jones

Executive Talent Acquisition

Angela.Jones1@ssmhealth.com

SSM Health is committed to equal employment opportunity based on race, color, religion, national origin, gender, sexual orientation, gender identity, pregnancy, age, physical or mental disability, veteran status, and all other statuses protected by law.

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Job Summary:

This is NOT a remote position. This role will require relocation to the St. Louis, MO metro area upon acceptance of the position.

Job Responsibilities and Requirements:

Drives strategy and operational effectiveness within assigned region and/or ministries through demonstrating operational effectiveness of care progression activities in alignment with our value-based care strategy. Provides regional physician leadership and physician coaching for all activities of care management, utilization management, and clinical documentation integrity. Collaborates with vendor partners, acting as a liaison and regional contact for organization’s physician advisor services.  Supports strategic goals and drives behaviors which achieve meaningful and measurable outcomes.  Acts as a change agent to achieve programmatic goals, while leveraging resources and utilizing strengths within the organization and through partnerships to identify and addresses local and regional factors which affect care delivery. Collaborates with the clinical leaders, case management, clinical documentation integrity (CDI), utilization management, and revenue cycle leadership to ensure quality and appropriate cost of care and utilization of services.

Department:

8745000033 Patient Experience

Work Shift:

Day Shift (United States of America)

Scheduled Weekly Hours:

40

SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity, pregnancy, veteran status, or any other characteristic protected by applicable law. Click here to learn more.