Medical Director Needed in Southwest Ohio!!
We are looking for a Market Medical Director who will be responsible for establishing strong collegial relationships with participating health plan physicians in each of his/her markets. Utilizing these relationships as well as available data, the Market Medical Director works to positively impact the quality and efficiency of care received by health plan members in each of these markets. The Market Medical Director will serve as the main liaison between the health plan and the provider community for all clinical issues.
What We Are Looking For:
- Population Health – collaborative care management leadership
Provides clinical leadership and development for a population health programs or functional area within Medical Management, e.g, patient centered medical home, health and wellness, population management, high risk care management, reporting capability, etc.
Assists in assuring appropriate health care delivery for the assigned membership and managing the medical costs associated with the assigned population.
Helps recruit, develop and motivate population health-care management staff.
Promotion of managed care systems using evidence-based medicine to educate and facilitate best practices with care management staff and medical providers.
Stratification, continuous evaluation and re-stratification of population for appropriate resource allocation. - Physician and provider relationship management
Responsible leading change with physicians and other providers, especially the practices, to improve the quality and efficiency of care in the network and integrate these providers into our clinical initiatives.
Visits network facilities on a regular basis, identifies key issues facing leaders and works collaboratively with leadership to accomplish mutually agreed upon goals.
Creates and maintain a system that gives feedback to providers individually and collectively regarding managed care effectiveness of individual providers and networks.
Nurtures a culture where delivering the highest quality yields lowest cost.
Participates in the development of physician incentives and gain sharing arrangements.
Develop, maintain and grow relationships with key clinical leaders with the assigned market.
Develops and executes market specific cost improvement initiatives. - Quality of care and service delivery
Provides guidance and interpretation on issues of medical appropriateness, benefit application as appropriate, level of care necessary to include out-of-network care.
Maintains up-to-date knowledge of new information and technologies in medicine.
Evaluates and ensures systems and processes to assist providers with adherence to evidence based protocols.
Chairs or staffs peer review committees and participates in the Appeals and Grievance process, as necessary, to assure timely, accurate responses to members.
Assures compliance related to Federal (e.g., CMS), State (e.g., Insurance commission) and local rules and regulations.
Minimum Required Education, Experience and Skills
Graduate of an accredited medical school, M.D. OR D.O. Degree is required.
Board Certified by ABMS recognized medical specialty organization.
3-5 years of clinical practice experience.
3 or more years of experience as a physician executive managing physician relationships.
3 or more years as a physician executive working at least part time on utilization management.
Proven ability in medical leadership position possessing clinical credibility with peers and the ability to be a team player and team builder.
A thorough understanding of all aspects of managed care, including HMOs, PHOs, risk arrangements, capitation, peer review, performance profiling, outcome management, care coordination, pharmacy management, and patient centered medical home concepts.
Excellent interpersonal, verbal, and written communication skills.
Consistently completes continuing education activities relevant to practice area and needed to maintain licensure.
Ability to navigate in a corporate matrix environment.
Preferred Education, Experience and Skills
2 or more years managed care of payor experience.
Board certification in internal medicine or family practice.
Physical and Mental Requirements
Ability to sit for extended periods of time.
Ability to properly drive and operate a vehicle.
Ability to receive and comprehend instructions verbally and/or in writing.
Ability to use logical reasoning for simple and complex problem solving.
**The material listed above is not comprehensive of all duties/responsibilities performed. This job description is not an employment agreement or contract. Management has the exclusive right to alter this job description at any time without notice.**
#J-18808-Ljbffr
