Executive Medical Director-Revenue Cycle

All the benefits and perks you need for you and your family:

• Benefits from Day One
• Paid Days Off from Day One
• Debt-free Education* (Certifications and Degrees without out-of-pocket tuition expense)

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: Full Time

Shift: Days

The community you’ll be caring for:

The Maitland Office Plaza houses our highly skilled teams that support our hospital system including Marketing, Patient Financial Services, Revenue Management, the Credit Union and Human Resources. 

The Trickle Building, a two-story office structure, creates an atmosphere of health and healing, with a healthy-style café and quaint chapel. 

The main lobby is filled with lush greenery and a light trickle of water, creating a holistic environment.

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:

· Responsible for reviewing and authorizing inpatient days and the evaluation of inpatient utilization patterns within service areas to identify areas of improvement, developing specific strategies and criteria addressing areas of need.  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.

· Participates with the Medical Directorate to review and develop medical guidelines and policies.  Advise and educate Care Managers regarding clinical issues. Act as liaison for and attending physicians to arrive at most appropriate inpatient/outpatient utilization determinations.  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.

· Reviews data and trends to identify opportunities for utilization improvement to positively influence practice patterns.  Conducts regular, ongoing meetings with Care Managers to ensure continuity and efficiency in the inpatient setting.  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.

· Collaborates and develops relationships with payers and the community health resources.  Actively contributes in efforts to monitor and reduce unnecessary length of stay.  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. 

· Acts as a liaison between contracted Managed Care/Commercial payers related to managed care denials, Care Management and the Hospital’s Medical Staff to facilitate the accurate and complete documentation for coding and abstracting of clinical data, capture of severity, acuity and risk of mortality, in addition to DRG assignment.  Establishes and maintains a presence within the Medical Staff structure and active participation on applicable committees (ie JOC/Payer, Revenue Cycle, Finance Committee, etc.).

The expertise and experiences you'll need to succeed:

LICENSURE, CERTIFICATION, OR REGISTRATION REQUIRED:

· Current, valid State of Florida license as a physician

· Board certified and eligible for membership on the Hospital medical staff