Talent.com
SSM Health
System Care Coordination & Physician Advisement DirectorSSM Health • Saint Louis, MO, United States
No longer accepting applications
System Care Coordination & Physician Advisement Director

System Care Coordination & Physician Advisement Director

SSM Health • Saint Louis, MO, United States
30+ days ago
Job type
  • Full-time
Job description

Job Title

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

MO-SSM Health Mission Hill

Worker Type: Regular

Job Summary: Provides enterprise physician leadership across utilization management, clinical documentation integrity, and denial prevention to ensure care delivered is medically necessary, accurately documented, and defensible. Serves as the system physician advisor, aligning clinical decision making with regulatory, payer, and documentation requirements while supporting physicians, Clinical Documentation Integrity (CDI), and care coordination teams to reduce denials and revenue leakage.

Job Responsibilities and Requirements:

PRIMARY RESPONSIBILITIES

  • Provides enterprise physician leadership for utilization management (UM), medical necessity, and level-of-care determinations, ensuring consistent, compliant decision-making across regions.
  • Serves as the system physician advisor, supporting and guiding physicians, care coordination, and leadership on complex clinical, regulatory, and payer-related questions.
  • Acts as the physician champion for Clinical Documentation Integrity (CDI), partnering with CDI and coding to ensure documentation accurately reflects clinical severity, complexity, and resource utilization.
  • Leads clinical validation strategy for denials, including Diagnosis-Related Group (DRG) downgrades and medical necessity disputes, ensuring defensible clinical rationale aligned with payer and regulatory standards.
  • Oversees and standardizes physician advisement workflows, escalation criteria, and best practices across regions to reduce variation and duplication of effort.
  • Collaborates closely with care coordination, UM, CDI, coding, revenue integrity, and managed care teams to align clinical decision-making with operational and financial goals.
  • Analyzes denial trends, utilization patterns, and documentation gaps at the system level, identifying root causes and preventive opportunities rather than isolated case fixes.
  • Provides physician-to-physician education and coaching focused on medical necessity, documentation quality, and defensibility, especially for high-impact service lines or payer risk areas.
  • Supports development and optimization of Epic workflows, data integrations, and reporting related to utilization review, physician advisor activity, and denial prevention.
  • Serves as a key physician leader in governance, performance oversight, and strategic planning related to care coordination, physician advisement, and denial prevention initiatives.
  • Works in a constant state of alertness and safe manner.
  • Performs other duties as assigned.

EDUCATION

  • Medical degree (MD or DO) with current licensure to practice medicine in the State

EXPERIENCE

  • Five years of healthcare experience, with two years' experience in healthcare administration; project work, physician advisor work or CDI work

Work Shift: Day Shift (United States of America)

Job Type: Employee

Department: 8740000033 Chief Nursing Officer

Scheduled Weekly Hours: 40

Benefits: SSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs.

  • Paid Parental Leave: we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE).
  • Flexible Payment Options: our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday.
  • Upfront Tuition Coverage: we provide upfront tuition coverage through FlexPath Funded for eligible team members.

SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity, pregnancy, veteran status, or any other characteristic protected by applicable law.

Create a job alert for this search

System Care Coordination & Physician Advisement Director • Saint Louis, MO, United States

Similar jobs

Director of Career Education - St. Louis, MO

concordanceSaint Louis, MO, United States
Full-time

Director of Career Education - St.Concordance's reentry program is designed to dramatically reduce recidivism by helping individuals with justice involvement lead meaningful, abundant, and joyful l... Show more

 • Promoted

Surgery Physician

Insync Healthcare RecruitersJerseyville, Illinois, US
Full-time

Surgery physician job in Illinois :.General Surgery opportunity 45 minutes from St.Excellent opportunity for a BC/BE General Surgeon with this top 100 rated rural hospital located in Southern IL ju... Show more

 • Promoted

Center Clinical Director

ChenMedSaint Louis, MO, United States
Full-time

We're changing lives every day.For both our patients and our team members.Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with y... Show more

 • Promoted

Director of Advancement, Siteman Cancer Center - University Advancement

Washington University in St. LouisSaint Louis, MO, United States
Full-time

Director Of Advancement, Siteman Cancer Center.The Director of Advancement, Siteman Cancer Center is responsible for raising private support for cancer research, education, and community program pr... Show more

 • Promoted

Global Clinical Program Strategy Director - Cigna Healthcare - Hybrid

eviCoreSaint Louis, MO, United States
Full-time

Principal, Global Talent Hub Clinical Lead.The enterprise clinical team is reimagining its global talent model to support The Cigna Group's Strategic Optimization Program (SOP).This program focuses... Show more

 • Promoted

Development Director

National Kidney FoundationSaint Louis, MO, United States
Full-time

Louis, MO (Hybrid - 2 days in office).Fueled by passion and urgency, the National Kidney Foundation is a lifeline for all people affected by kidney disease.As pioneers of scientific research and in... Show more

 • Promoted

Medical Corps Officer (Physician)

US NavyColumbia, IL, US
Full-time

Medical Corps Officer (Physician).Medical Corps Officers are Navy physicians who provide high quality medical care to Sailors, Marines, their families, and humanitarian missions around the world, p... Show more

 • Promoted

Physical Therapist Float - Metro East IL

Athletico Physical TherapyAlton, IL, United States
Full-time

Position Overview Flexibility of a 4 day work week About Us: At Athletico, we believe in the power of support - because a little help can lead to extraordinary achievements.Physical therapy isn'... Show more

 • Promoted

Clinical Director (Medical)

She Recruits LLCSaint Louis, MO, United States
Full-time

A rapidly expanding, physician-led primary care organization is seeking a Center Clinical Director to lead one of its senior-focused outpatient centers in North St.This is an opportunity for a high... Show more

 • Promoted

Associate Medical Director | $293K | No Weekends

Purple Cow RecruitingSaint Louis, MO, United States
Full-time

Full time outpatient primary care leadership position in St.Combine administrative oversight with direct patient care within a mission-driven community health center.Structured schedule with no nig... Show more

 • Promoted

Executive Director, Center for Advanced Dental Education

Saint Louis UniversitySaint Louis, MO, United States
Full-time

Executive Director, Saint Louis University Center for Advanced Dental Education.Saint Louis University (SLU) Center for Advanced Dental Education seeks a dynamic leader for the role of Executive Di... Show more

 • Promoted

Vice President of Physician Services

ConfidentialJerseyville, IL, United States
Full-time

Vice President of Physician Services.Reputable healthcare organization providing primary & secondary care services to the local community.The Company is seeking a Vice President of Physician Servic... Show more

 • Promoted

Service Center Director

Salvation Army Central TerritoryArnold, MO, United States
Part-time

The Salvation Army Midland Division Corps located in Arnold MO, is looking for an individual who would like to apply their experiences to fill their Service Center Director position.This position i... Show more

 • Promoted

Physical Therapist

Select Medical CorporationArnold, MO, United States
Full-time

Overview SSM Health Physical Therapy Arnold, MO Physical Therapist (PT) * Full Time* SSM Health Physical Therapy is the premier provider of comprehensive outpatient services! With a network of... Show more

 • Promoted

PATIENT DINING ASSOCIATE (DIETARY AIDE) (TEMPORARY)

Compass Group USA IncAlton, IL, United States
Full-time +3

Morrison Healthcare * We are hiring immediately for temporary PATIENT DINING ASSOCIATE (DIETARY AIDE) positions.Location: Alton Memorial Hospital - 1 Memorial Hospital, Alton, IL 62002.Note: onlin... Show more

 • Promoted

Director of Wellness Center

Jersey Community Hospital (JCH)Jerseyville, IL, United States
Full-time

Assumes responsibility for the overall management of the Wellness Center Facility.Develops and directs individual and/or group wellness programs and activities, in coordination with Physical Therap... Show more

 • Promoted

Clinical Partnership Coordinator

Alteas HealthSaint Louis, MO, United States
Full-time

Clinical Partnership Coordinator.Help Shape the Future of Patient Care.The Clinical Partnership Coordinator is a field-based position that combines clinical support with facility relationship manag... Show more

 • Promoted

Associate Director of Sales

Sunrise Senior LivingSaint Charles, MO, United States
Full-time

Why Join Sunrise Senior Living At Sunrise Senior Living, we believe meaningful work starts with purpose.Our team members are passionate about making a positive difference in the lives of residents... Show more

 • Promoted

Program Supervisor

SevitaArnold, MO, United States
Full-time

Program Supervisor - Lead with Purpose, Make a Difference Every Day Starting Pay: $23.On-Demand Pay | Full Benefits Package Experience as a Direct Support Professional (DSP), Caregiver, or Team Lea... Show more

 • Promoted

Director, Medicaid & Marketplace Client Strategy - Evernorth Health Services - Hybrid

CarepathRxSaint Louis, MO, United States
Full-time

Director, Medicaid & Marketplace Client Strategy.We are looking for a strategic and forward-thinking leader to shape how we support Medicaid and Marketplace clients in a rapidly evolving environmen... Show more