The Medical Director Provides medical leadership and has responsibility for Health-care-related management oversight activities including Utilization Management, Network Management, Quality Improvement. Responsibilities include facilitation of evidence-based and cost-effective professional and institutional services to our membership through oversight of day to day operations as well as mentoring and assisting in training of clinical and non-clinical leaders to ensure compliance with legal and requirements. Chairs and/or participates in various committees to support performance improvement, improve quality of medical care and the physician and patient experience - including, but not limited to oversight of peer review and risk management. Engages physicians to promote relationships and alignment with organizational goals.
Strategic: * Collaborates with Chief Medical Officer (CMO) and Senior Leadership to develop and implement strategic plans to achieve the company mission and vision. * Collaborate with director of clinical pharmacy services to improve utilization of most clinically and cost effective medications including infusions, injections and generics. * Responsible for planning and development of strategies to reduce inappropriate emergency department and urgent care utilization. * Collaborates with team members in the development, implementation, management, monitoring and evaluation of the effectiveness of chronic disease programs. * Collaborates with team members in the development, implementation, management, monitoring and evaluation of the effectiveness of programs to achieve preventative care targets. * Coordinates with the Medical Director of Performance Improvement in the development, collation and reporting of quality metrics such as P4P, 5-Star and ACO quality measures and performance standards. * Collaborates with contracting, medical management and leadership on incentives, metrics, clinical programs and training that will improve the quality of care provided to our members along with decreasing costs. * Assists in management and implementation of system initiatives. * Provides leadership through participation in or oversight of appropriate committees, teams and boards. * Identifies, trains, evaluates and develops physician leaders and both clinical and non-clinical staff. * Collaborates with Information Technology on all clinical systems. * Represents GNP and MemorialCare Medical Foundation to employer groups, physician groups, individual physicians, managed care organizations, and state medical associations and societies. * Collaborates with the Practice Transformation Team to develop and implement strategies that impact patient, provider and staff experiences.
Operations: * Oversees the clinical decision making and leads the Utilization Management/Case Management/Disease Management programs with a focus on adherence to best practices and value-based care utilizing software or other systems for disease management, risk stratification, and predictive modeling. * Oversees (Assistant) Medical Director(s) responsible for inpatient services with attention to average daily census and length of stay in contracted and non-contracted hospital facilities, Long-Term Acute Care (LTAC) facilities, Sub-Acute facilities, Skilled Nursing Facilities and Rehabilitation facilities * Oversees elective surgery costs, volume and facilities. * Oversees medical specialty utilization and costs. * Oversees patient steerage to preferred facilities. * Monitors the performance of network physicians with regard to the cost, clinical appropriateness and volume of authorizations. Director shall meet with network physicians and especially outlier physicians as necessary to present such data and ensure compliance with goals and targets. * Oversees the management of tertiary care referrals and utilization. * Participates in GNP and MGMF committees as needed or directed (e.g. Quality, utilization management, credentialing, etc.) * Analyzes clinical and financial data to develop and refine management activities, investigate and define sources of variation, and ensure conformance with standards and criteria. * Collaborates with Business Intelligence to monitor medical and surgical utilization patterns and costs. * Directs the high-risk patient care team in their management of complex or high-cost members and implement processes to improve end-of-life care as well as appropriate utilization of hospice and palliative care services. * Promotes system-wide efforts to improve the quality of care to all patients through physician education, relationships, and implementation of organizational structures (like the patient-centered-medical-home and incorporation of specialty clinics). * Leads efforts to increase overall quality through participation in peer review, credentialing, QI department and grievances/appeals and monitor HCC coding initiatives and implementation of best practices, (patient experience/satisfaction, service culture and quality metrics. * Assists in managing and developing an effective network through hiring, firing, disciplining, compensating, incentivizing, contracting, mentoring, relationship-building and educating IPA physicians. This includes Pod development as well as managing relationships with health plans and hospitals. * Works with Health Plans and collaborates with other medical groups to identify best practices.
Successful clinical practice experience
Medical leadership position such as assistant/associate medical director
Oversight responsibility (i.e. participation in Board of Directors/Chief of Staff)
Knowledge: * Familiarity with provider management principles * Demonstrated ability for team building * Familiarity with data analysis and statistical evaluation * Excellent ability to effectively communicate Company Vision and Goals
Special Skills/Equipment: * Willingness to participate in education programs * Enthusiasm for innovation and technological advancement * Demonstrated effective interpersonal skills, and oral and written communications skills
Education/Licensure: * MD/DO with current license by California Medical Board * Board Certification