Medical Director, Utilization Management and Physi

at Cook County Government in Chicago, Illinois, United States

Job Description

Job Posting:Jun 14, 2024, 10:44:24 AMClosing Date:OngoingFull-timeShift Start Time:8:00A.M.Shift End Time:4:30P.M.
Collective Bargaining Unit:NONEPosting Salary:COMPETITIVE
Organization:Health and Hospital Systems

Applicants may apply for this position by submitting a resume/ CV to the following email address: mgmtrecruit@cookcountyhhs.org
When submitting a resume/CV by email, you must include the job title and posting number in the subject line of your email. An application or resume/CV must be filed for each position which interests you.
To receive Veteran Preference, appropriate discharge papers must be attached to the online application or must be included with your emailed resume/CV. Please refer to Veteran Preference document requirements listed on the bottom of this posting.
Job Summary
The Medical Director, Utilization Management and Physician Advisory Services (Medical Director) will ensure effective and efficient delivery of quality medical care throughout Cook County Health (CCH) consistent with federal, state, and regulatory standards for physician utilization review management.The position will also be responsible for overseeing the clinical documentation improvement efforts. The Medical Director will work with CCH senior leadership to identify opportunities to improve Utilization Management and clinical documentation improvement programs.The position will provide oversight over documentation requirements to support coding, reimbursement, quality and outcomes measurement and medical necessity for the services provided.

General Administrative Responsibilities

Collective Bargaining
*Review applicable Collective Bargaining Agreements and consult with Labor Relations to generate management proposals
*Participate in collective bargaining negotiations, caucus discussions and working meetings

Discipline
*Document, recommend and effectuate discipline at all levels
*Work closely with labor relations and/or labor counsel to effectuate and enforce applicable Collective Bargaining Agreements
*Initiate, authorize and complete disciplinary action pursuant to CCH system rules, policies, procedures and provision of applicable collective bargaining agreements

Supervision
*Direct and effectuate CCH management policies and practices
*Access and proficiently navigate CCH records system to obtain and review information necessary to execute provisions of applicable collective bargaining agreements

Management
*Contribute to the management of CCH staff and CCH' systemic development and success
*Discuss and develop CCH system policies and procedures

General Administrative Responsibilities continued
*Consistently use independent judgment to identify operational staffing issues and needs and perform the following functions as necessary; hire, transfer, suspend, layoff, recall, promote, discharge, assign, direct or discipline employees pursuant to applicable Collective Bargaining Agreements
*Work with Labor Relations to discern past practice when necessary

Typical Duties
*Oversees and provides guidance to Utilization Management, Physician Advisors, and clinical documentation improvement programs.
*Partners with Revenue Cycle and Health Information Management Leadership to create seamless interface with clinicians. Provides oversight over the Clinical Documentation Improvement Program, ensuring effective and efficient documentation.
*Oversees the Physician Advisor staff in the education of medical staff and house staff on new clinical practice guidelines, protocols, research evidence and regulatory requirements including, but not limited to, ICD-10, meaningful use, Centers for Medicare & Medicaid Services (CMS), Joint Commission and compliance.
*Measures and analyzes outcomes for inpatient and observation days. Monitors physician and group patterns and reports the information to physician and hospital committees.
*Chairs and oversees the Stroger Hospital Utilization Management Committees (UMC) and provides feedback to Ambulatory and Community Health Network and Provident Hospital.
*Attends clinical department meetings sharing information specific to department utilization performance, updating the department on internal or external utilization practices, educating physicians on statistical and other review techniques.
*Leads and oversees Utilization Management and Case Management at Stroger Hospital and Provident Hospital.
*Assists with providing leadership and oversight to staff to improve discharge, utilization, length of stay, readmission rates and transitions.
*Contributes to reviews cases under dispute with third party payers and presents the hospital's case to third party payor Medical Director or Peer Review Board to overturn denials and receive payment.
*Identifies barriers to timely discharge and assists with developing solutions to remove... For full info follow application link.

COOK COUNTY HEALTH AND HOSPITALS SYSTEM IS AN EQUAL OPPORTUNITY EMPLOYER