Position Purpose
This position is responsible for clinical and medical administrative leadership for Value Based Care initiatives and programs specifically designed for Renown Medical Group and any potential affiliates and partners. In partnership and collaboration with RMG clinical and administrative leadership and other Renown partners, this medical director will provide training, analysis, and program design for programs that include the design and implementation of Risk based strategies including utilization management programs for RMG and care delivery strategies to improve patient outcomes. This position reports to the Renown Medical Group Chief Executive Officer.
Nature and Scope
Expectations of this position include the following items:
- Design and build Value based Health Medical Services organization to meet the needs for UM, capitation, risk-based payment. Quality management, and compliance for all Risk based, shared savings, or quality bonus arrangements.
- Maintain understanding of competitive landscape and serve as internal and occasional external-facing thought leader for value-based care initiatives, opportunities, and collaborations.
- Provide subject matter expertise, claims processing, utilization management, case management, design and implementation of Value based care initiatives, enhanced processes of care, contracting, and payment integrity.
- Perform or supervise as needed Utilization Management, Quality Improvement, Care Management, and Risk Adjustment activities related to the patient population served by Renown Medical Group and/or affiliates.
- Identify and execute administrative expense and medical cost savings opportunities and care optimization.
- Partner with operational and technology leadership to define and improve upon our role in Utilization Management, case management, and options for best practice care delivery initiatives.
- Collaborate with other clinical leaders to develop clinical strategies to improve patient outcomes.
- Inspire others and provide clinical and medical administrative subject matter expertise as needed.
- Stay abreast of regulatory and accreditation requirements and ensure that these are met.
- Stay abreast of all payor contract requirements that are value based in nature and assure that the initiatives for these are designed, monitored, and implemented.
- Work in collaboration with Decision Support and other reporting teams to advise and review designs for medical cost and care management opportunities for individual risk stratification and management as well as population health initiatives.
- Provide education and training related to these initiatives, managed care policies, processes, and strategies including Medical Director and Section Chief mentoring, Training to UNR residency programs and other academic and non-academic audiences as requested.
This position does not provide patient care.
Disclaimer
The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.
Minimum Qualifications
Requirements - Required and/or Preferred
| Name | Description |
| Education: | Must have working-level knowledge of the English language, including reading, writing, and speaking English. Medical Degree from Accredited University. |
| Experience: | Minimum of five (5) years post graduate clinical practice experience in direct patient care. Ten or more years of experience in the managed care environment which includes significant involvement with utilization/quality issues, risk adjustment, and pharmacy management issues. Experience in managing risk-based contracts and utilization in an insurance and/or Medical Group environment. At least 5 years of experience in managing Medicare Advantage, ACO, or Medicaid risk arrangements. Demonstrated leadership and administration and medical ability of high caliber. This position should be filled by a recognized industry expert in the areas as noted above. |
| License(s): | Must possess and maintain a current and valid State of Nevada Doctor of Medicine (MD) or Doctor of Osteopathic (DO) medicine license. Ability to obtain and maintain a valid State of Nevada driver's license and ability to pass Renown Health's Department of Motor Vehicle Report criteria. |
| Certification(s): | Board certified and verified by American Board of Medical Specialties. |
| Computer / Typing: | Must be proficient in Microsoft Office Suite, including Outlook, PowerPoint, Excel, Teams, and Word and have the ability to use the computer for online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc. |
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