Medical Director - Physician Advisory Services
CHRISTUS System Office
CHRISTUS Corp Irving Offices 919 and 909 Buildings
919 Hidden Ridge
Irving, TX 75038
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The Medical Director will provide leadership to Physician Advisor teams across the entire Christus Health system primarily in the area of utilization management and review. She/he will work collaboratively with utilization management/case management leaders across the system to deliver the best in utilization management services. The incumbent in this role will be instrumental in the development and evolution of the new internal Physician Advisory Services department. Serving as the dyad partner to the System Director- Care Management to standardize Utilization Review (UR) activities, UR Committee compliance with CMS Conditions of Participation, and collaborating with Managed Care leadership to develop operational processes that align with and optimize institutional payor strategies. This includes the establishment of a new committee structures to improve throughput, reduce length of stay, and denial associated with post-acute transitions of care.
- Able to work in a highly matrixed environment and comfortable achieving results through influence, collaboration and positive relationship development. Able to develop and operate effectively in dyad relationships
- Ability to function at a high level in a self-directed, dynamic environment
- Excellent facilitation, conflict resolution and interpersonal skills
- Excellent verbal and written skills
- Ability to be flexible and adapt to unique site needs
- Comfortable providing in person communication and presentation in front of large groups
- Demonstrates tact in dealing with potentially sensitive situations
- Builds mutually trustworthy relationships and is viewed as an individual of honesty and high integrity
- Conducts themselves in a calm and collected manner at all times
- Demonstrates patient/customer focused, compassionate behavior
- Takes responsibility for decisions, actions and results and delivers on commitments
- Manages complex, cross functional projects to conclusion
- Practices financial stewardship of resources
- Cooperates and collaborates with team members and others
- Complies with the Employee Conduct of Conduct and all other System and Hospital institutional policies and procedures
- Ability to work under fast paced conditions
- Willing to travel as needed
- Demonstrates compliance with all federal, state and local laws and regulations.
- Consistently demonstrates adherence to the mission, vision and values of CHRISTUS Health.
- Provides leadership and oversight of Physician Advisor teams and services across the entire CHRISTUS Health System.
- Develops the CHRISTUS Health System Utilization Management Committee and ensures that a system utilization management plan is fully implemented and kept up to date. Also ensures that individual facility Utilization Management Committees work in coordination with the system committee to achieve optimal results and reduce variation in activities across the system. Will ensure that all facilities meet appropriate regulatory and accreditation requirements related to utilization management and review (Conditions of Participation of the Centers for Medicare and Medicaid Services). Develops and recommends short and long-term goals for utilization management services.
- Will ensure that individual facilities have procedures in place to ensure effective utilization review is being conducted to include appropriateness of admission, level of care criteria, continuing stay, length of stay, medical necessity of services and appropriate post-acute disposition (transitions of care).
- Develops, monitors and updates as needed benchmarks and metrics to measure and monitor system utilization management functions and appropriate financial and operational goals are achieved. Develops performance reports, dashboards and other communications as needed for system and site leadership.
- Develops and leads a system-wide operational structure consisting of site Physician Advisor medical directors to ensure that utilization review functions are performed in a timely and appropriate manner as well as at a best practice level.
- Provides education/mentorship to Physician Advisors across the system.
- Maintains current knowledge of the legal, regulatory and compliance environment as related to utilization management. Ensures that local Physician Advisor, case management and administrative teams are kept up to date on these issues.
- Maintains familiarity and currency in medical necessity criteria - Milliman Care Guideline and InterQual Criteria
- Manages and/or assists in the recruitment, development and supervision of team members. Creates and sustains an environment that fosters team member engagement. Establishes clear objectives tied to department and/or organizational strategic goals. Coaches, counsels and evaluates performance of direct reports. Promotes individual professional growth and development.
- Works with Executive Leaders at the system and/or local level on planning efforts and operational direction in utilization management process improvement opportunities to ensure aligned and efficient workflows across the system.
- Participates in strategic planning and/or serves as a sponsor or team member for performance improvement projects in utilization management.
- MD or DO degree from an accredited medical school
- 3 to 5 years of experience in a clinical setting
- 3 to 5 years of experience in a Physician Advisor role or equivalent
- 3 to 5 years of experience in leadership and/or management roles
- Board certification as a Physician Advisor by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) preferred
- Additional management training as evidence by a MMM, MBA, MHA, etc. degree preferred
- Board certified in a clinical specialty
- Travel 25-40%