Practicing Medical Director

Sky Mavis • Remote (MA, United States) • $200k - $250k / year • 1m ago

The Practicing Medical Director is responsible for medical oversight of the Medical Management Program Description of P3 Health Partners regarding medical necessity decisions, utilization review, inclusive of prior authorization, concurrent and retrospective review, discharge planning and transitions of care to the appropriate level. The Medical Director supports achieving the Quadruple Aim: improved outcomes, improved patient experience, improved clinician experience and decreased cost of care. The Practicing Medical Director will spend 50% of their time seeing patients.

Education and Experience:

Current, unrestricted, Nevada medical license (MD or DO)
Training or Interest in Geriatrics welcome but not required
Current DEA license
Advanced degree such as MBA, MHA, MPH or MMM preferred
Board certified and primary care preferred
Board Eligible or Board Certified in Family or Internal Medicine
Appropriate unrestricted state medical licenses
Minimum 5 years practice experience
Minimum 2 years as a lead physician
Experience in managing Medicare Advantage (MA) populations in global risk arrangements preferred
Knowledge of utilization management to include experience applying medical management treatment guidelines and nationally recognized criteria, such as CMS NCD/LCD, InterQual / McKesson, MCG, or other practical management guidelines required

Knowledge, Skills and Abilities:

Strong problem-solving skills required
Excellent at both physician and patient engagement strategies
Experience in a managed care organization preferred
Knowledge of medical terminology required
Excellent communication skills with patients, providers, internal and external customers required
Must have excellent computer skills
Must have excellent organizational skills, attention to detail, and ability to work independently

Essential Functions:

Promote the mission, vision and values of P3 Health Partners
Responsible for medical necessity decisions and peer to peer communications
Plans and directs medical policies
Responsible for strategic clinical relationships with physicians, identifying clinical trends, and directing data analysis
Responsible for quality and continuous improvement
Responsible for all actions/responsibilities as described in P3 controlled documentation for this position
Contributes to and supports P3 quality initiatives
Leads and contributes to Quality Committee Governance
Assist in developing in Utilization Management and Quality Management programs
Develops policies and procedures, guidelines, and training to ensure compliance with federal, state, NCQA, health plan, and internal regulations
Researches, identifies, and implements new technologies that contribute toward increased quality
Leadership through designated monthly meetings
Some travel required
Other duties as assigned

Benefits:

Top of the market guaranteed Compensation with bonus structure, sign on, relocation if needed, and full benefit package.
Quality of care focus, spend quality time with your patients, partners, and each other.

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