Whitney Ranch
1500 W. Sunset Rd
Suite 100-120
Henderson, NV 89014, USA
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 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 (Potential need to meet/visit other markets to promote P3 Health Partners recruiting events, etc.)
Licenses & Certifications:
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)
#J-18808-Ljbffr
