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 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
- Other duties as assigned
Compensation:
- 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.
Qualifications
Education
Preferred
Masters or better.
Licenses & Certifications
Required
DO License
MD License
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
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