Medical Director - Care Management Job Listing at Holyoke Medical Center in Holyoke, MA (Job ID 8492)

Description

The Medical Director - Care Management, reporting to the Chief Medical Officer, is a physician serving the hospital through teaching, consulting, and advising both the case management department and the hospital on matters regarding physician practice patterns, over and under-utilization of resources, medical necessity documentation, compliance rules and regulations, collaborative and relationships with payers and the community. The Medical Director - Care Management is a key member of the hospital#s Care Management/UM team charged with meeting goals of quality and cost. The Medical Director - Care Management works with the medical staff leadership, the attending medical staff, the full-time hospital-based physicians, medical staff APP#s, residents, the departments case management/social work, and utilization management teams to develop and implement methods to optimize use of hospital services for all patients while also ensuring the quality of care provided. This includes working with those developing case management protocols, working with physicians and others to reduce length of hospital stay, ensuring patients are in the appropriate level of care, and monitoring the appropriate use of diagnostic and therapeutic modalities and documentation improvement. # Non- Clinical Responsibilities: 0.5 FTE equivalent, 20 hours per week, Monday to Friday onsite. On Call remote input to CM/UM on cases as need basis in rotation with Physician advisor over weekends for appropriate level of care determination Utilization Management: Reviewing and advising on the appropriateness of patient admissions, length of stay, and level of care.# Care Coordination and Transitions: Participating in care plans, ensuring timely and effective care progressions, and smooth transitions between levels of care.# Medical Necessity and Compliance: Ensuring that care provided is medically necessary and complies with regulations and payer requirements.## Denial and Appeal Management: Engaging with insurance companies and appealing denied or downgraded claims.# Clinical Documentation: Providing guidance and support to physicians on proper documentation practices to ensure accuracy, completeness, and compliance with regulations.# Quality Improvement: Participating in quality improvement initiatives, reviewing patient outcomes, and identifying areas for improvement.# Education and Advocacy: Educating and mentoring medical staff and care management teams on best practices and relevant regulations.# Collaboration: Working with various hospital departments and committees to address quality, safety, and compliance issues.# # Clinical Responsibilities: 0.5 FTE equivalent, 20 hours per week, Monday to Friday onsite. Oversee ED throughput, with focus on patients boarding in ED to be admitted, needing clinical care input from medical provider at Hospital Medicine Supervise and mentor advance practicioners, at Hospital Medicine, covering med/surg floor, Behavior Health units Provide safe and quality care to all patients under supervision or direct care Co-ordinate and collaborate with Chief and Assistant Chief of hospital medicine Directly report to CMO for ongoing clinical and management issues as and when arise # # #