Medical Director of Documentation & Utilization Excellence

Location: Idaho-Boise
Duration: Permanent - Full Time
Job ID: 21939835
Category: Physician Administration Job
Company: Saint Alphonsus Medical Group
Contact: Whitney Clark
Call: (208) 731-8007
Practice Type:   Hospital
Job Posted: 05/04/20

Medical Director of Documentation & Utilization Excellence - 21939835

Saint Alphonsus Health System is currently seeking a Medical Director of Documentation & Utilization Excellence. Appointed and evaluated annually by the Saint Alphonsus Chief Clinical Officer, the Medical Director of Documentation and Utilization Excellence (MDUE) is the lead provider for coordination and oversight of both utilization management efforts and documentation excellence initiatives. The MDUE will have an established record of clinical excellence and credibility. Will be familiar with hospital medicine and principles of proper utilization and appropriate clinical documentation. The MDUE will work in a dyad partnership with the SAHS Director, Clinical Resource Management.
 
Time Commitment – 0.7 - .8 FTE Administrative / 0.2 – 0.3 Clinical
 
ESSENTIAL FUNCTIONS:
  1. Responsibilities
    1. Consistently emulates the SAHS mission and guiding behaviors.
    2. Perform Physician Advisor role in determining and arbitrating level of care determinations performing Peer-to-Peer reviews with insurance companies who are denying an inpatient level of care. Complement current physician advisor efforts at completion of second level reviews for patients not meeting inpatient criteria.
    3. Participates in local Utilization Review Committee and be a member of appropriate committees and teams to improve utilization, care transitions and appropriate clinical documentation as assigned.
    4. Engage in physician-to-physician communication to provide just-in-time education and resolve conflicts regarding utilization concerns and clinical documentation excellence education.
    5. Conduct rounds to monitor compliance with developed policies and procedures for bed placement, accurate reporting of bed status.
    6. Assist case managers, utilization review nurses and social workers to overcome barriers as they identify patients ready for transfer or discharge.
    7. Participate as needed in forums to manage day-to-day bed management issues, especially during times of HVM (high volume management) including treat & transfer discussion and decisions.
    8. Arbitrate admission and discharge decision made by other physicians as deemed appropriate.
    9. Refer individuals to the appropriate chain of command who demonstrate patterns of physician behavior that impede the throughput process.
    10. Assist as requested in the role out of EMR initiatives.
    11. Lead Health Grades and other clinical initiatives that rely heavily on excellence in clinical documentation.
  2. Communication.
    1. Communicates using multiple methods with their constituency.
      1. Attends required meetings as determined.
      2. Feels comfortable providing in person communication and presentation in front of large groups.
      3. Is able to maintain timely email communication with colleagues.
  3. Mentorship.
    1. In collaboration with SAHS administration, helps oversee and provide mentorship to hospital based providers regarding utilization and clinical documentation.
  4. Quality and Risk.
    1. In collaboration with the SAHS administration, risk and legal teams, assures that medical utilization and documentation programs are compliant with legal and regulatory requirements.
    2. Participates in peer review activities as requested.
    3. Identifies human resource, compliance and risk management issues, reports those risks to SAHS leadership and/or SAHS Office of the General Council, or the SAHS Compliance Officer as appropriate.

Saint Alphonsus Health System is a growing four-hospital, 714-bed, 74 clinic integrated healthcare system serving southwestern Idaho, eastern Oregon and northern Nevada. Saint Alphonsus Health System is a member of Trinity Health, one of the largest Catholic not-for-profit health systems in the nation. To learn more about Saint Alphonsus, please visit [link removed]

Boise, Idaho's Capital City anchors a vibrant and growing mid-sized metropolitan area of 730,000 people. An outdoor enthusiast's paradise with a flourishing arts and entertainment scene, the region offers a reasonable cost of living, low crime rate, excellent cultural programs, neighborhood parks and nearby forests and rivers. Idaho's culture of physician independence also makes it one of the best places in America to be a practicing physician.


SKILLS, KNOWLEDGE, EDUCATION AND EXPERIENCE:

  1. Requires all skills, knowledge, education, licensing, certification, experience and essential functions to function in the role.
  2. M.D / [link removed]
  3. A minimum of two years' experience in hospital based medicine with exposure to utilization management and documentation initiatives.
  4. Demonstrated teamwork, performance analysis, presentation, interpersonal, facilitation, planning, and communication skills.
  5. Ability to build and maintain positive rapport with dyad partner, SAHS leadership, peers, physicians and staff.
  6. Ability to work with Trinity Health experts in managing and developing medical utilization programs and documentation initiatives.