Oklahoma Regional Vice President Care Coordination Liaison, Physician and Provider Advisement

It's more than a career, it's a calling.

OK-SSM Health St. Anthony Hospital - Oklahoma City

Worker Type:

Regular

Job Highlights:

PRIMARY RESPONSIBILITIES

• Collaborates with vendor partners to ensure appropriate balance of advocacy and support for patients, families, practitioners and professional staff and the organization.
• Serves as the regional/ministry physician expert, providing medical direction and oversight to care management, utilization management and clinical documentation integrity (CDI) including length of stay management, complex care rounds, clinically and integrated networks.
• Acts as primary contact for regional leadership with physician advisor services through oversight of vendor services to improve our appropriateness of care progression. Ensures services support the regional and/or ministry unique factors affecting care delivery and care progression.
• Uses operational knowledge of Center for Medicare Services (CMS) guidelines and a keen understanding of the payor market and managed care contracts to monitor vendor service performance as well as the total operations for care progression for the organization. Remains current on healthcare and payor regulatory provisions. Exhibits understanding of value-based care models, including perspective of care delivery focused on the right intervention, at the right time, and in the right care setting.
• Monitors metrics to drive performance improvement opportunities to achieve the highest quality and regulatory compliance through partnership with regional leaders and vendor.
• Acts as escalation point for case prioritization with physicians and care management leaders for challenging, high conflict or outlier case circumstances. Collaborates with stakeholders across the care continuum to ensure success throughout various stages of vendor relationship and care progression activities.
• Provides CDI medical oversight and follows up on individual peer to peer conversations regarding CDI queries.
• Partners with vendor service, revenue cycle team, physicians, payors and Care Transformation leadership for education and communication to achieve desired outcomes.
• Develops effective and positive relationships with multiple stakeholders assuring successful implementation and maintenance including managing timelines, resources, and deliverables.
• Demonstrates respect and values the contributions of all disciplines, building relationships that foster trust and confidence for all departments and teams involved with patient care.
• Actively participate in a leadership capacity in system and region governance for Care Transformation including serving as primary lead for the governance for Utilization Management.
• Oversees and is responsible for utilization management committee and governance for their respective region.
• Accountable to the regional leadership team for denial management, medical necessity, and appropriate utilization of inpatient resources including providing strategic and operational guidance/partnership to the regional leadership team on these issues.
• Recruits, engages, develops, leads, and manages assigned staff.​
• Performs other duties as assigned.

EDUCATION

• Doctorate from an accredited school of medicine  

EXPERIENCE

• Seven years' experience, with two years in leadership

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Named One of America's Greatest Workplaces for Diversity 2023 - Newsweek

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SSM Health is a Catholic, not-for-profit health system serving the comprehensive health needs of communities across the Midwest through a robust and fully integrated health car