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Executive Medical Director Revenue Cycle - Maitland, United States - Adventist Health System
Description
All the benefits and perks you need for you and your family:Our promise to you:
Joining AdventHealth is about being part of something bigger.
It's about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit.
AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.Schedule:
FT
Shift :
Days - This is On Site position
The role you'll contribute:
As the physician advisor, the Executive Medical Director of Revenue Cycle educates, informs, and advises members of the Case Management, Revenue Cycle, Patient Financial Services, Patient Access, AHS Managed Care departments and applicable Medical Staff of specific updates, statistical trending and/or changes related to denial prevention measures for our contracted managed care payers.
The Medical Director is responsible for providing physician review of utilization, claims management, and quality assurance related to inpatient care, outpatient care/observation stays and referral services.
This position supports the CMO capacities at the facilities within the Central Florida Division - South by ensuring the delivery of high-quality, efficient healthcare services throughout the continuum of care for the membership served by contracted medical group provider networks.
The Medical Director is an important contact for clinicians, external providers, contracted health insurance payers, and regulatory agencies.It also serves as subject matter expert, providing clinical expertise and business direction in support of medical management programs, promoting the delivery of high quality, patient focused and cost effective medical care.
Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.The value you'll bring to the team:
Collaborates with Senior Medical Officers with contracted managed care payers regarding utilization review management activities and maintain a positive and supportive relationship between the inpatient facilities, health plans and physicians (hospitalist groups and primary care providers), as well as interdepartmental liaison for ACO activities and program development.
Reviews and responds to Complaints & Indicators. Works in close coordination with the processes of the Utilization Review Management staff for continual process improvement and reporting.Reviews and makes recommendations on appealed provider claims and makes determinations for appeals & grievances from members.
Provides support, shares administrative call, and maintains collaborative relations with the other medical directors.
Assists in other duties related to utilization review and quality improvement of the network as assigned by the Division CFO/SrVP, Vice President of Revenue Cycle Operations and/or Director, Utilization Review Management.
Performs other duties as assigned.
Develops clinical care pathways and utilization benchmarking for specialty groups within the West Florida Division.
Manages specialty-specific quality screens and utilization outliers.
Participates in review of long stay patients, in conjunction with the Director of Utilization Review Management to facilitate the use of the most appropriate level of care.
Provides education and serves as a resource to Medical Staff colleagues regarding best practices, Care Management structure, and functions and uses of clinical guidelines.
Develops and facilitates productive internal/external relationships with all physicians and constituents of Care Management.Establishes and maintains a presence within the Medical Staff structure and active participation on applicable committees (ie JOC/Payer, Revenue Cycle, Finance Committee, etc.).
C OMPLIANCE/ R EGULATORY R ESPONSIBILITY :
O PERATING & C APITAL B UDGET/ F INANCIAL R ESPONSIBILITY :
S TRATEGIC P LANNING R ESPONSIBILITY :
P ERFORMANCE I MPROVEMENT R ESPONSIBILITY :
C OMMUNITY R ELATIONS R ESPONSIBILITY :
Category:
MGT
Organization:
AdventHealth Central Florida
Shift: - Day
Req ID:
We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.