Medical Director
3 weeks ago
ORANGE, CA – REMOTE (MUST LIVE IN SOUTHERN CALIFORNIA)
The Medical Director of Outpatient Care provides medical leadership and has responsibility for Health-care-related management. Responsibilities include facilitation of evidence-based and cost-effective professional and institutional services to our membership through oversight of the day-to-day operations as well as mentoring and assisting in the 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.
JOB RESPONSIBILITIES/DUTIES
Collaborates with team members in the development, implementation, management, monitoring and evaluation of the effectiveness of members under case management as well as in chronic disease programs, i.e. CHF, as well as to achieve preventive care targets.
Oversees the clinical decision making and leads the 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.
Directs the high-risk patient care team in their management of complex members and implements processes to support end-of-life care as well as appropriate utilization of hospice and palliative care services.
Provide physician oversight of the Utilization Management and Prior Authorization process to ensure the delivery of cost effective, high quality, and appropriate medical care as needed. This includes adherence to the company’s denial process and compliance with industry standards and denial ratios. Works closely with UM team members in meeting timely turnaround on referrals
Collaborates with multiple departments on incentives, metrics, clinical programs and training that will improve the quality of care provided to our members along with decreasing costs.
Promotes system-wide efforts to improve the quality of care for all patients through physician education and relationships. Manages relationships with health plans.
Works proactively and collaboratively across the organization to ensure overall business objectives are met and supported. Attends various meetings and participates on committees as appropriate contributing ideas for improving efficiency, productivity, and member satisfaction.
QUALIFICATIONS
Minimum Education:?Licensed Medical Doctor in the State of California, board-certification preferred.
Minimum Experience:?Seven (7) years of clinical care experience. Strong clinical acumen. Some experience in medical leadership or oversight responsibilities required.
Req. Certification/Licensure:?Licensed Medical Doctor in the State of California, board-certification required - Internal Medicine, Emergency Medicine or Family Practice
#CARE6
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