Associate Medical Director

Position Type: Full-Time and/or Part-Time

Location: 100% Remote: This position is 100% remote, with the possibility of being hybrid.

Most of the positions at YCCO are hybrid, meaning they have the flexibility to work both remotely and/or in-person.

Department: Heath Plan Operations FLSA Status: Exempt

Reports To: Chief Medical Officer (CMO) Physical Strength: Light (L)

Learn more about Yamhill Community Care: click her

Summary

Under the direction of the Chief Medical Officer (CMO) works in matrixed collaboration with the Care management (CM), Utilization Management (UM) Management, and the Health Plan Operations teams. The Associate Medical Director is responsible for performing CM and UM program duties, and other clinical practice improvement initiatives as defined. This position may be assigned to lead medical management, clinical informatics, behavioral health, and/or population health initiatives for the organization including clinical quality in coordinated care and the Coordinated Care Organization (CCO) / provider network, as well as utilization, quality, case management, and disease management operations, monitoring and results. The position will provide ground level clinical direction in support of call clinical programs, transformation, and process improvement efforts.

Essential Duties

* Provides day-to-day clinical decisions and consultation to Care Management and Utilization Review staff.
* Builds and maintains relationships with Yamhill Community Care (YCCO) members, providers, and community partners to ensure care needs are identified and positive outcomes are met.
* Collaborates with staff, providers, and community partners to establish and make available resources and support that meets the needs of YCCO members.
* Demonstrates balance and equity with advocating for patient and family-centered care, medical and professional staff, and organizational stewardship.

Job Duties

Care Management

* Develops, implements, and manages clinical and wellness programs to address the needs of members.
* Implements, directs, and oversees utilization, case, disease, and/or quality management programs.
* Advises physicians regarding patient status and appropriate and necessary documentation.
* Facilitates and participates in multi-disciplinary team (MDT) and interdisciplinary care team (ICT) meetings and other case consultation.
* Supports efficient patient care, appropriate patient placement, and effectively coordinates with stakeholders across the continuum of care.
* Applies patient-centered care planning techniques and motivation interviewing to elicit patient-focused goals and priorities to develop care plans and transcend barriers.
* Functions as a liaison between CM staff and providers / community resources to facilitate access to timely and effective care.
* Demonstrates teamwork and communication to include early collaboration when issues arise utilizing team-based problem-solving and planning.
* Provides care in the context of the identity, culture, health status, and health needs of the individual.

Utilization Management and Transitions

* Supports clinical decisions of prior authorization and concurrent review cases to achieve timely and effective care across the continuum.
* Participates in case consultation reviews regarding levels of care, length of stay, resource utilization and avoidable delays.
* Applies clinical knowledge for appropriate length of stay.
* Supports care management in progressing care to meet length of stay goals.
* Builds community relationships with vendors / community providers to enhance access to covered services.
* Drives performance improvement.
* Participates in the appeals process.
* Performs clinical reviews on cases referred by healthcare professionals and ensures quality and effective patient care is provided.

Clinical Documentation

* May partner with CCO leadership team to develop, implement, direct, and oversee programs that provide clinical strategy and interventions to CCO clinical systems.
* Collaborates with clinical documentation team to ensure timely documentation to support working diagnostic-related group (DRG), in compliance with International Classification of Disease ICD 10 requirements.
* Follows up with physicians and professional staff to address documentation deficiencies and to update on procedural and terminology changes.
* Drives performance improvement by sharing physician-specific data regarding length of stay (LOS), readmissions, use of hospitalist program and case denials.

Essential Department & Organizational Functions

* Works to cultivate and develop inclusive and equitable services, and working relationships with diverse groups of employees, community partners, and community members.
* Participates in the preparation and submission of regulatory and contract required deliverables.
* Works closely with other YCCO departments, including Compliance to assist with audits; including the External Quality Review (EQR), as needed.
* Proposes and implements process improvements.
* Meets deadlines for completion of assigned responsibilities and projects.
* Maintains agreed upon work schedule with punctual, regular, and predictable attendance.
* Demonstrates cooperation and teamwork using a professional and respectful demeanor.
* Respectfully takes direction from Supervisor.
* Other duties as assigned.

Knowledge, Skills, & Abilities

* Demonstrates up-to-date knowledge of newest technologies, clinical practice guidelines and treatments.
* Strong knowledge of medical and Centers for Medicare and Medicaid Services (CMS) regulations.
* Serves as a resource for clinical documentation integrity (CDI) and coding specialty.
* Strong working knowledge of chronic disease states and medical management of these states.
* Focused customer service skills and excellent problem-solving skills.
* Ability to build rapport with medical staff and management leadership to obtain necessary approvals of new strategies for utilization management.
* Knowledge of current medical literature, research methodology, healthcare delivery systems, healthcare financial/reimbursement issues, and medical staff organizations.
* Dedication to the delivery of high-quality, cost-effective, efficient patient care services.
* Excellent organizational skills including ability to handle multiple priorities and demands simultaneously in a dynamic work environment while maintaining high attention to detail and accuracy.
* Ability to work independently, use sound judgment, anticipate next steps and be proactive as part of a diverse team within a Matrix or shared resources across departments work model.
* Excellent computer skills, including Microsoft Windows, Word, Excel, and Outlook.
* Ability to communicate both professionally and effectively in all forms of communication.

Supervisory Responsibilities

This position has no supervisory responsibility.

Qualifications

Ability to perform essential job duties with or without reasonable accommodation and without posing a direct threat to safety or health of employee or others. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

Education & Experience

Required:

* Minimum five (5) years of clinical practice.
* Two to three (2-3) years of experience in health plan, medical group or hospital utilization management position involving utilization, appeals and grievance, and retrospective review.

OR:

* Any combination of education and experience that would qualify candidate for the position.

Preferred:

* Three (3) years of progressively responsible managerial experience is highly desirable, preferably to include managed care, quality assurance, utilization review and case management experience.
* Experience with mental health / addiction disease services (strongly preferred).
* An administrative graduate degree, certificate of educational achievement in medical administration, or equivalent is desirable.

Certificates, Licenses, and/or Registrations

Board-certified physician (MD or DO), medical doctor (Internal Medicine, Family Practice preferred,) with a current unrestricted license to practice.

Physical Demands & Work Environment

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential duties of this position. The work environment characteristics described here are representative of those an employee encounters while performing the essential duties of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit, stand, walk, use hands and fingers, handle or feel, and reach with hands and arms. The employee is occasionally required to climb or balance, stoop, kneel, crouch or crawl. The employee may occasionally need to lift and/or move up to 25 pounds.

This position operates in a professional office environment and requires frequent use of standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. Specific vision abilities required by this job include close vision, color vision, distance vision, depth perception, and ability to adjust focus. The noise level in the work environment is usually moderate.

This position may include occasional required or optional travel outside of the workplace, in which the employee's personal vehicle, local transit, or other means of transportation may be used.