The Community Care (CCS) MD or DO is responsible for the Deputy Chief responsibilities as part of the medical oversight of the Community Care needs of the Veterans at NMVAHCS. The MD/DO also functions as a liaison between the Veteran, NMVAHCS and community medical providers to include hospitals, medical offices and private providers. The MD/DO has medical oversight by the Chief of Community Care Service, and reports to the Chief for administrative duties. Duties include, but are not limited to: Complete Medical and Clinical CCS Reviews on Non VA Care Patients and Selected Specialties. Review and make recommendations of STAT CCS Consults as needed. Review Urgent Non VA Care Consults, Provide Clarification of Requested Care and Expedite Processing of Requests. Review and Assist with Resolution of Complex CCS Medical Cases Generated by Congressional Inquiry or Patient Complaint/Appeal. Complete CCS Medical Reviews on Secondary Authorization Requests; Verify Proper Justifications, Urgency, Appropriateness and Availability of Care within VA System on all Non VA Care Consult Referrals. Schedule and conduct regular meetings with community partners. Encourage Non-Contracted providers/vendors to contract with Choice, provider agreements, etc. Participate in on-going Choice/national program office meetings and conference calls. Attend weekly nursing meetings as needed, CCS staff meetings and VA medical staff meetings and provide updates on Medical CCS issues. Attend various other Non VA Care, VISN or National Level Conference calls pertaining to Choice, Mission Act, CCN, Consults or other CCS medical issues. Provide training to VA Providers and enforce compliance to Non VA Care/Choice processes. Serves as POC for VA and Community providers regarding Non VA Care/Choice Programs. Responsible for attending Non VA Care/Choice related training including process changes, reviewing New Patch releases and providing staff with feedback on how it impacts the clinical review process. Complete reviews on secondary authorization requests if necessary. Must be extensively familiar with guidelines and standards relating to CCS processes to ensure timely completion of consults. Work closely with Registered Nurse Manager, Tri-West Regional Director and/or Tri-West Medical Staff on complex cases and care concerns/issues. Maintain constant liaison and works closely with community hospital and provider representatives to ensure maximum interchange of information necessary to accomplish the CCS mission/Mission Act implementation. Review consults for completeness and accuracy and provides feedback for quality control to VA providers. Work closely with RN Manager to provide suggestions and assist in implementation on system and process improvements. Work Schedule: Monday through Friday, 8:00 am to 4:30 pm Recruitment/Relocation Incentives: Yes Compressed/Flexible: No Virtual: No EDRP: No Financial Disclosure Report: Not required NOTE - Incumbent could also require to work at our downtown location at 500 Gold Ave, SW, Dennis Chavez Federal Bldg. Parking is not paid by the VA so it would the employees sole responsibility to pay daily parking.
Internal Number: 597009600
About Veterans Affairs, Veterans Health Administration
Providing Health Care for Veterans: The Veterans Health Administration is America’s largest integrated health care system, providing care at 1,255 health care facilities, including 170 medical centers and 1,074 outpatient sites of care of varying complexity (VHA outpatient clinics), serving 9 million enrolled Veterans each year.