Presence is exceptional care that delivers exceptional outcomes. We would like to invite you to share that gift as our new Medical Director of Case Management for SSM Health - Southern Illinois Region. We are seeking a well-roundedMedical Director who has the proven ability to engage with their medical staff and hospital leadership and who share our dedication to exceptional care and outcomes.
In addition to being a strong leader and providing support to the Regional Chief Medical Officer for the Southern Illinois Region, the Medical Director will:
- Provide physician advisory services which directly affects hospital reimbursement, CMI, and other utilization metrics through supporting case management, close relationships with medical staff, communication and knowledge of payer practices, and responsibility for hospital utilization metrics.
- The ideal candidate will possess strong leadership skills that will play a key role in impacting the rate of observation versus inpatient care.
- Review referred medical records and addresses the clinical theory of diagnosis for admission status, continued stay and in coordination of written appeal letters to payors.
- Work with the denials/appeals team in concurrent chart review to assess denials and appropriate levels of care.
- Daily concurrent chart review as needed by the Case Managers to review current treatment plans, identify unnecessary delays in care, and assist the case managers in facilitating care with the health center and functioning as a liaison to the attending physicians to provide the highest quality of care in the most efficient manner possible.
- Participates in CDMP program, and addresses any cases referred by the Clinical Documentation Specialists.
- M.D. or D.O.
- Hold and maintain an unrestricted medical license in the state of Illinois
- Meet the requirements (and become a member) of the Hospital medical staff
- Strong computer skills and working knowledge of the EPIC EMR
- Must have at least 3 years of clinical experience
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