Job Title: System Medical Director, Endeavor Health Physician Partners

Job Summary

The Integrated Medical Director of Endeavor Health Physician Partners (EHPP) oversees the performance of the Clinically Integrated Network (CIN) and collaborates with EHPP physician leadership to achieve the organization's CIN objectives. The role will work collaboratively with the CIN leadership team that supports the work across the system.  Additionally, the Integrated Medical Director will collaborate with the physician leadership of the system-employed medical group to enhance ambulatory quality, safety, utilization, and patient experience within the group. The EHPP Integrated Medical Director will also collaboratively work with the Primary Care Pod Leaders to advance system CIN initiatives, and elevate issues specific to practices within their Pod.

Essential Functions and Responsibilities

Quality/Utilization Management Improvement and Clinical Program LeadershipDirects the medical management, care coordination and quality improvement activities of the CIN and monitors all reports, information summaries, relevant publications, and clinical, utilization, and financial data related to these activities.

Leads the planning, development, and implementation of strategies for improving health outcomes, quality care delivery and cost containment in conjunction with the CIN leadership team, Physician Leadership Council and relevant CIN board committees.

Engages and maintains relationships with independent and affiliated physician leaders in the community.

Works collaboratively with Primary Care Pod Leaders to develop and execute a strategy to improve quality and population health outcomes.

Oversees the development of disease-management and performance programs intended to develop and disseminate tools and resources needed by physicians to further the clinical and operational goals of the CIN.

Partners with acute care CMO and system-medical group and other practice-based physician leadership to ensure there is alignment and coordination of key initiatives and to support the implementation of key tactics across all of the relevant care settings.

Participation in advancing system-wide approach to medically complex population across the care continuum to reduce acute care utilization and overall reduction in cost of care.

Develop and implement protocols, policies and procedures and regular feedback related to clinical and utilization management performance.

Participates in community outreach efforts to educate and engage physicians around clinical integration activities for pediatric patients.

Serve as the content expert for new and emerging practices to improve ambulatory quality and population health.Facilitates the review of quality and efficiency metrics to be applied to physicians participating in the CIN and the specific site and leads the development of recommended performance thresholds for incentive-based payments based on selected metrics.

Actively work to create a culture of safety and to ensure that all members of the health care team (including the patient and family) feel that their voices are heard.   Model the behaviors and organizational standards to promote quality and patient safety.Participate in training in QI tools and approaches so these are consistently deployed across the organization.Effectively communicate the goals and expectations of team members, so that the work across the team is aligned and synergistic.EHPP Payer-based Delegated DutiesIn partnership with CIN leadership, approve and support implementation of the Utilization Management Plan.

Supervise Utilization Management decision making activities including medical necessity and managed care administrative determinations, referrals management, peer review, denials and case management activities.

Support Stewardship initiatives in partnership with practicing physicians and relevant subject matter experts (inclusive of imaging, pharmacy and safe prescribing, as well as laboratory and appropriate test ordering).Ambulatory Clinical Documentation Integration (a CDI)Works with a CDI specialists as well as assigned practices or providers to educate and provide HCC audit and other performance results to clinicians aimed at ensuring HCC documentation and coding is complete and accurate.  

Educates, coaches and train peers on specific HCC improvement opportunities identified in auditing and data review as well as general knowledge. This will be performed one-on-one, or in groups, and should be  aimed at ensuring accurate coding and a complete and accurate medical record.Liaison between the assigned a CDI specialist  and clinician resolving documentation and coding errors. This includes direct outreach to clinicians with escalation queries and verbal communication for incomplete or unresolved documentation queries.

Maintains a high-level knowledge of ICD-10 as relevant for ensuring complete and accurate HCC documentation and coding, understands ICD-10 and HCC regulations, and governing bodies for rules and regulations relevant for their application.

Contribute to overall a CDI program improvement, including changes in EHR applications, review of vendor support, and other operational needs as they arise.

As this job evolves, this role will complete other duties assigned.

Qualifications:

Member of the professional staff at an entity hospital within Endeavor HealthDeep knowledge of ambulatory quality, patient safety, population health, and managed careUnderstanding of regulatory bodies and statutes that cover value-based care

Minimum Education Level

MD or DO from an accredited medical school.Completion of residency training and board certification and maintenance of board certification in the individual’s specialty area

Minimum Licensure Requirements

Must have an unrestricted medical license for the state of Illinois.Must be a member of the professional staff at an entity of Endeavor Health

Minimum Certification Requirements

Certification in quality (IHI Open School, LEAN/Six Sigma Certification and/or similar training), patient safety (CPPS), risk management (CPHRM) preferred.

Minimum Work Experience

Minimum of 5+ years of post-residency clinical practiceAt least 2 years of experience in patient safety, risk management or quality improvement with escalating leadership responsibilities across the acute care health setting

Knowledge, Skills and Abilities (KSAs)

The successful candidate will possess excellent communication, facilitation, analytical and motivational skills consistent with effective change management and innovation deployment. Leads people by effectively sharing information, building effective teams, showing compassion and possessing self-knowledgeBuilds alliances through organizational agility and negotiating skillsLeads change by managing vision and purpose, dealing with ambiguity, and demonstrating managerial courageDrives results by being data-driven, maintaining a customer focus, striving for results and communicating effectively.Demonstrates ability to effectively communicate verbally and in writing.Demonstrates ability to present information to a variety of audiences.     Focused, results driven, and able to collaborate with and lead others in direct and matrix management reporting structures.Fluent in process improvement methods and tools to evaluate, measure capability, and redesign operational and clinical processes. Function independently with data analysis, trending and understanding of statistical methods to determine impact of change. Interpret and display data in manner that identifies areas of opportunity and engages leaders to identify tactics for care improvement. Coordinate and lead multidisciplinary teams independently for both long term projects and ad hoc needs.Translates clinical questions into reporting requirements and coordinate with EPIC teams to deploy workflows and requirements of defines measures.Learns and maneuver multiple databases to glean insights and identify opportunities for improvement.Leads and directs Care Transformation Managers and others in accordance with strategic plans of the organization.

Scope: People Management

The expected number of direct reports is tbd and a dozen or more indirect resources.  This includes Care Transformation Managers.

Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals – Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) – all recognized as Magnet hospitals for nursing excellence. For more information, visit www.endeavorhealth.org.  

Diversity, equity and inclusion is at the core of who we are; being there for our patients and each other with compassion, respect and empathy. We believe that our strength resides in our differences and in connecting our best to provide community-connected healthcare for all.

EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor

Molly Meyer

Physician Recruiter

Email: mmeyer3@northshore.org

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