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Medical Director

2 months ago

Bakersfield, California, United States Kernfamilyhealthcare Full time
Job Description

Company Overview

Kern Family Health Care is a leading healthcare organization dedicated to improving the health status of our members through an integrated managed healthcare delivery system.

Job Summary

We are seeking a highly experienced and skilled Medical Director to provide clinical leadership and guidance in the development and measurement of our strategic approach to quality, performance improvement, and patient satisfaction.

Key Responsibilities

  • Provide clinical oversight and leadership for the Medicare/DSNP program.
  • Assist in short- and long-range program planning, total quality management (quality improvement), and external relationships.
  • Develop and implement systems and procedures for all medical components of health plan operations.
  • Collaborate with the Chief Medical Officer and others to create and implement health plan medical policies and protocols.
  • Monitor provider network performance and report all issues of clinical quality management to the Chief Medical Officer and Quality Improvement Committee.
  • Represent the health plan on various committees and report to the Board of Directors on credentialing and re-credentialing of network providers.
  • Provide medical oversight into the medical appropriateness and necessity of healthcare services provided to Plan members.
  • Meet medical cost and utilization performance targets.

Requirements

  • Licensed M.D. or D.O. in good standing in the state of California.
  • Board certification in their area of specialty by the American Board of Medical Specialists (ABMS).
  • Minimum of five (5) years of established clinical experience.
  • Knowledge of the managed care industry, including Medicare, Medicaid, and commercial products.
  • Experience in population health management and use of data to design and implement clinical programs.
  • Experience working with different levels of staff in a matrix organization.
  • Strong analytical, problem-solving skills, and good negotiation skills.
  • Very strong interpersonal skills, including the ability to establish and maintain effective working relationships with individuals at all levels.
  • Effective oral and written communication skills.
  • Ability to supervise and mentor staff, analyze situations independently, and make appropriate decisions.
  • Ability to prepare written reports and maintain accurate records in compliance with state and federal requirements.

Preferred Qualifications

  • Medical utilization management experience.
  • Working with health insurance organizations, hospitals, and other healthcare providers.
  • MSO, patient interaction, etc.

Knowledge and Skills

  • Extensive knowledge of the use of MCG guidelines in clinical decision making.
  • Knowledge of medical management systems and software to support clinical activities in health services.
  • Experience in population health management and use of data to design and implement clinical programs.
  • Knowledge of Medicare/DSNP.

Other Requirements

  • Possession of a valid California Driver's License and proof of valid State required auto liability insurance.
  • Travel up to 10% required.
  • May be requested on occasion to travel to conferences and meetings as an organization representative.

Equal Opportunity Employer

Kern Family Health Care is an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis.