Chief Medical Director, Population Health

2 months ago

Orange, United States Prospect Medical Holdings Full time
Job Description

The CRC Chief Medical Director provides medical leadership and has responsibility for clinical management oversight activities of the CA CRC Dual Risk Members. Responsibilities include facilitation of evidence-based and cost-effective chronic care, social and institutional services to our dual risk 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 managed care requirements. Medical Director works 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.

Responsibilities

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.
  • 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.
  • 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.


Qualifications

Experience:
  • Successful clinical practice experience.
  • 5 years Medical Leadership position such as assistant/associate medical director.
  • Oversight responsibility (i.e. participation in Board of Directors/Chief of Staff).
  • Board Certified Medical Doctor in the State of California.
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.


About Us

Prospect Medical Holdings' ability to deliver quality, compassionate care during the unprecedented pandemic affirms the original vision of its founders. This is the fulfillment of the hopes Prospect's founders had for the company, and proof that a clear vision, an insightful operating model, and a commitment to communities and our employees, born in the past, remains the way of the future.

Every day, our more than 11,000 affiliated physicians and 18,000 employees at 17 hospitals, 165 outpatient centers and 28 medical groups provide nationally recognized care in six states. Our comprehensive network of quality healthcare services is designed to offer our patients and 600,000 members highly coordinated, personalized care tailored to the unique needs of each community we serve-many of which provide essential medical services to underserved communities as safety-net hospitals.

The compensation of the successful applicant will be determined at the time of the offer. In determining the compensation offered to an applicant, the Hiring Manager considers many factors including but not limited to, the candidate's relevant work experience, education, certifications and licensure, internal peer equity, local market, as well as organizational considerations.

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