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Medical Director Community Health
2 months ago
The Medical Director, Community Health, serves as a key medical leader in the organization, driving program development and oversight of Community Health initiatives. This role ensures that programs align with operational systems and tools, while also conducting utilization reviews of cases.
Key Responsibilities- Provide and oversee the delivery and quality assurance of prior and retrospective authorization processes for CalAIM Community Supports and related benefits.
- Participate in the oversight, support, and relationship management with delegated medical groups and plan partners (Anthem Blue Cross, Care 1st, and Kaiser).
- Work closely with the Community Health team and overall leadership to develop and implement programs, policies, and procedures.
- Apply clinical, operational, strategic, and provider engagement skills to ensure program success for vulnerable eligible members and providers.
- Perform utilization reviews and determinations, address grievances and appeals, and participate in inter-disciplinary case conferences with Care Management teams.
- Collaborate with hospitals, Federally Qualified Health Centers, primary care practices, and community-based organizations to develop and implement effective programs.
- Doctor of Medicine (M.D.) degree.
- At least 8 years of clinical medicine experience after medical school.
- Demonstrated experience working in a collaborative or matrix relationship.
- Experience in maintaining liaison with Federal, State, and local bodies and medical organizations.
- Physicians with social service experience in governmental programs, social service organizations, or non-healthcare related organizations.
- Experience working with underserved, safety net populations, including those who are homeless, persons with disabilities, seniors, foster children, and youths.
- Demonstrated history working with community groups and organizations.
- Demonstrated experience in developing and implementing programs, policies, and procedures.
- Demonstrated ability to provide leadership to physicians, nurses, and other healthcare professionals.
- Demonstrated ability for teamwork and collaborative problem-solving.
- Demonstrated strong analytic ability.
- Excellent written and verbal communication skills, negotiating skills, consensus building, and teamwork.
- Demonstrated ability in public relations, including effectiveness in working with community groups and organizations.
L.A. Care offers a wide range of benefits, including Paid Time Off (PTO), Tuition Reimbursement, Retirement Plans, Medical, Dental, and Vision, Wellness Program, and Volunteer Time Off (VTO).
