AVP, Medical Director & Care Coordination - Care Coordination - IMC

The AVP Medical Director of Care Coordination has oversight of Care Coordination department/programs, including Case Management, Utilization Management, Social Work, Complex Case Management, and Physician Advisor Services throughout its six (6) facilities that provide services in inpatient, emergency department, satellite emergency department, observation, outpatient, and behavioral health settings. The position dually reports to two (2) Chief Medical Officers (CMOs) and has five (5) direct reports: 1) Network Director of Case Management, 2) Network Director of Social Work, 3) Network Director of Complex Cases, 4) Physician Advisor of three hospitals, and 5) Physician Advisor of three hospitals. The AVP, Medical Director of Care Coordination collaborates with Network and Hospital leaders to ensure the successful implementation of Care Coordination programs. The AVP, Medical Director of Care Coordination works collaboratively with Inspira leaders that are both Network-based and Hospital-based in areas such as Nursing, Medical Staff, Operations, Quality/Regulatory, Medical Affairs, Risk Management, Compliance, Legal, Physician Practices, Finance (including Payor Contracts), Health Information Management (including Clinical Documentation Improvement), Epic implementation team member, and Patient Experience. He/she also works collaboratively with leaders of external agencies (in conjunction with applicable Inspira leaders) in the areas of joint ventures for home care, post-acute care facilities, NJ state regulatory personnel, NJ Court representatives, Centers for Medicare and Medicaid Services (CMS) representatives, regulatory/accreditation representatives, New Jerseys Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), and others The AVP, Medical Director of Care Coordination works with the CMOs to ensure care coordination programs and services: • align with the Networks strategic plan and organizational improvement initiatives • meet or exceed federal, state, local, and payer requirements • reduce or eliminate penalties (and achieve bonus payments) for federal programs related to readmission reduction and value-based purchasing • reduce or eliminate penalties (and achieve bonus payments) for the more numerous non-federal payers related to readmission reduction and value-based purchasing • meet or exceed compliance requirements • support the organizations throughput improvement goals • reduce barriers associated with complex case management • are performed by team members who receive initial and ongoing training to keep abreast of internal and industry changes • are performed by team members who work at the top of their license• are designed to assure evidence-based practice standards are achieved • align with the Networks High Reliability Organization initiative • are designed to be as efficient as possible • are performed with maximum and efficient use of the organizations electronic clinical information system • are supportive of existing Union contracts • are designed to ensure the maximum and efficient use of the Cerner and Epic clinical information systems. Position Experience Required • Minimum five years of experience in utilization management, care management, and/or physician advisor role in an acute care hospital; System/Network experience preferred • Leadership role in care management, utilization management, and/or physician advisor role in an acute care hospital; System/Network experience preferred • Experience overseeing unionized team members preferred • Experience in designing (or at least using) Cerner and Epic preferred Position Qualifications (details here or list below) • Doctor of Medicine Degree (MD) or Doctor of Osteopathy (DO) Degree • Successful completion of a residency program accredited by ACGME or AOA, preferably in Internal Medicine or Family Medicine • Board Certification required, preferably in Internal Medicine or Family Medicine; experience in Hospital Medicine preferred • Certification by the American College of Physician Advisors (or equivalent certification) required (or achieved within one year of employment) • New Jersey Medical License • New Jersey CDS Active, DEA Certificate Active?>