At PopHealthCare, our mission is simple - to lead the effort in reimagining how healthcare is delivered. We are bold innovators, dedicated to making a difference and we hire wicked smart people!
Job Description
About Emcara Health Value-Based National Medical Group: Our mission is simple leading the effort to reimagine how health care is delivered for our nations most vulnerable seniors and adults. Improving the lives of those most in need guides everything we do, and we believe that as we continue to stay focused on that compass heading, we will increasingly be recognized as Americas leading national medical group providing house calls for vulnerable populations.
We have brought the same focus to the experience of our own team members as we have to our patients, and through the prioritization of Joy In Work have made the Quadruple Aim in health care delivery our clinical true north.
Emcara core care teams are multi-disciplinary and include Community Health Workers (CHW), Registered Nurses (RN), Advanced Practice Providers (APP- NP/PA), and complex care physicians (CCP), among other care coordination and specialized resources such as palliative care and behavioral health clinicians, Clinical Pharmacists, Pharmacy Technicians, Social Workers (SW), Physical Therapists, and Registered Dieticians (RD).
Our care teams understand that vulnerable populations require a new brand of care to live their healthiest life possible- home-based advanced primary care. Advanced primary care is comprehensive, and includes medical, behavioral, and social care, and can be delivered either as the PCP of record, or in collaboration with patient PCPs to deliver an added layer of support.
Value-based payment methodologies allow our physicians and APPs both the time they need to restore the clinician-patient relationship, as well as ensure the patient and clinician are surrounded by a care team that is able to address all their care needs, especially their behavioral and social needs.
Role Summary: While formally reporting to the Chief Medical Officer (CMO) and based in the indicated market, the Medical Director functions in a highly matrixed organization that allows for close working relationships with and shared accountability with Operations Leadership. This individual will have demonstrated throughout their career an unparalleled dedication to and success in achieving equitable health outcomes, both as an individual practitioner, but more importantly through leading teams, as well as through program creation and management.
This individual will be a key contributor to the development and execution of all national clinical programs, with shared oversight and accountability of the performance of their market(s). This leader pursues the highest clinical performance across our integrated suite of in-home care solutions, including in-home assessments, social determinants of health, transition of care, and advanced primary care.
This senior leader will work side-by-side with the VP Market Operations to identify, implement, and improve care solutions to achieve the Quadruple Aim in health care delivery, and will bring an unparalleled ability to act as a cross-functional leader internally, collaborating across the enterprise to accomplish goals.
This is a get into the weeds, build-it and make it better kind of job, requiring high energy, deep engagement, and a strong work ethic. This individual understands the necessity of offering differentiated treatment models for seniors and vulnerable populations across a broad chronic illness spectrum and will be able to effectively build will and implement innovative care solutions.
The Medical Director must have a strong desire to continue delivering direct patient care while providing excellent leadership across critical functional areas. This role will spend at least 20% of their time dedicated to providing consultative or direct care to the most complex patients in our populations across markets. Consultative care will include serving as the physician consultant during multi-disciplinary case conferences and through shadowing provider visits in person. Direct patient care will be delivered via telephonic, telehealth, or in-person modalities. This will include time to complete administrative duties such as clinical documentation and care coordination.
Role Responsibilities:
- Devote the necessary time and energy to ensure the most effective partnership with their operational dyad leader (VP Market Operations)
- In partnership with your dyad partner, SVP Population Health, SVP Clinical Quality, Initiatives, and Product Integrity, and other key stakeholders- Build/Grow an innovative, high-performing primary care practice that carries an excellent reputation among communities of patients and the health care delivery ecosystem
Support market budgeting and forecasting for our care solutions to allow for the necessary people, process development, and technologies to maximize the sustainable delivery of the quadruple aim over time.
Meet or exceed market-level quadruple aim targets, including Team Experience/Joy In Work, Patient Experience- Net Promotor Score, Better Care- admission, readmission, quality metrics, Lower Total Cost of Care- MLR, total cost of care reduction.
Continuously analyze market, practice, and provider-level KPIs to identify opportunities to improve clinical and operational execution, including review and implementation of best practice execution, and targeted continuous improvement initiatives.
Work towards codification of our care model to enable effective, scalable growth through standardization of 80% of care delivery across markets regardless of population or geography, with 20% comprised of variable care model elements that address any market-specific requirements dictated by the unique needs of the population, contractual or regulatory requirements.
Through cost of care analyses identify strategies for medical cost reduction, and lead their implementation.
Provide clinical documentation/risk adjustment and quality (HEDIS/Stars) leadership and oversight of these and other clinical scorecard elements at the provider, practice, and market level to achieve and sustain industry leading performance.
Enhance our multidisciplinary team approach to caring for patients, including role optimization of all care team members, particularly our community health worker and field nurse roles, in pursuit of decreasing clinical variation.
- Partner with the National Medical Director of Behavioral Health Care Solutions to support the continued integration of evidence-based and high value interventions for our highest risk population living with primary or comorbid mental health conditions and/or substance use disorders- Enhance behavioral-related support for our care teams and patient population through the development and implementation of a behavioral health care manager team and the workflows to ensure seamless integration.
- Partner with the VP National Pharmacy Care Solutions to enhance pharmacy-related support for our care teams and patient population through the development and implementation of a pharmacy care team and the workflows to ensure seamless integration.
Support the development and application of evidence-based medication use strategies to enhance patient and population health outcomes.
Continuously evaluate pharmacy expense and opportunities to utilize lower cost alternatives with comparable effectiveness.
- Partner with the VP Community Health and Wellness to support the delivery of care that address the social barriers our patients face to live their healthiest life possible.
Support the development of a best-in-class community health worker role.
- Additional responsibilities- Support the ongoing development of the Emcara Health Operating Platform, including serving as a clinical and care delivery subject matter expert in EMR and care management system implementations and refinement.
Partner with our Talent Acquisition and local leadership Teams to recruit and hire the best clinician leaders and care team members, orienting them toward a value-based model of care that includes a strong focus on home-based care solutions that consider behavioral health conditions and social determinants of health.
Provide direct supervision, coaching, and mentorship to a team of advanced practice providers (who operate independently) and/or complex care physicians.
When indicated, communicate closely with other healthcare providers so that primary and specialty care is well coordinated, including the use of virtual consult platforms.
Lead clinical education and quality improvement activities and meetings at the market level.
Partner with local health plan and risk-bearing provider group clinical leaders to ensure that joint goals are achieved.
Participate in local business development initiatives to facilitate the growth of the primary care practice.
Up to 25% travel time.
Other duties as assigned.
Qualifications
We are searching for a special breed of health care professional who embodies the following qualities and characteristics: heart and commitment to serve vulnerable populations, passion, and perseverance to achieve long-term goals (a.k.a. grit), team-based and social determinants of health orientation, and embrace change in a rapidly evolving health care delivery system. Flexible and dynamic, this self-starting individual will be a creative problem solver with a proven record of accomplishment of successful implementation of innovate health care delivery solutions. They must possess excellent time management and organizational skills, with the ability to prioritize and multi-task. Additional qualifications include-
- Graduate of an accredited medical school.
- Public health, business administration, or health administration studies preferred.
- Board Certified in Internal Medicine, Medicine/Pediatrics, or Family Practice.
- Additional board certification in Emergency Medicine, Gerontology, or Palliative Care is preferred.
- At least three years of post-residency clinical experience delivering care to complex patients preferred, including in the home and skilled nursing facility settings.
- Recent or current experience as a hospitalist physician preferred.
- Strong knowledge of best clinical practices as they relate to population health management.
- Must be skilled in delivering care across medical, behavioral, and social needs, particularly for patients living with mental illness and substance use disorders.
- HEDIS/Stars and HCC/Risk adjustment knowledge.
- Strong communication skills with the ability to collaborate and work with multiple stakeholders.
- Proven track record of leading and building teams to drive measurable clinical, operational, and financial results.
- Demonstrated ability to collaborate both internally and externally with multi-disciplinary care team members.
- Active medical license in the indicated State, or ability to obtain one within 90 days.
- Waiver to prescribe approved buprenorphine products to treat Opioid Use Disorder, along with related training, preferred (if not, expectation will be to become waivered within first 120 days).
- Must have current state and federal DEA certification.
- Current Certification in AHA or ARC Basic Life Support for health care providers required for employment.
- Working knowledge of computers and ability to document effectively and efficiently in an electronic medical record system.
- Drivers license requirements: licensed for a minimum of 3 years without restrictions; no DUI or other felony driving conviction in the past 7 years.
Additional Information
All your information will be kept confidential according to EEO guidelines.
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