Medical Director

HYBRID ROLE Medical Director

This is a hybrid role with remote work and travel between Santa Clara and San Joaquin County, CA.

Medical Director opportunity Health Plan or IPA experience in California

I'm networking. Maybe you can help me. My California client has an opening for a Medical Director.

To help them this physician needs:

• 5+ years clinical practice
• Health Plan or IPA experience in California
• Expert knowledge of public payer health care programs (Medicare, Medicaid)
• Expert knowledge of provider reimbursement strategies, in-depth understanding of value-based models
• Demonstrated knowledge and successful track record of health plan operations including utilization and care management, claims processing, contracting and provider relations, and regulatory compliance required.

Does someone come to mind? I would appreciate your assistance.

I'm available from 6 to 8 EST at 678-725-5752.

Warm regards,

Bob

Bob Hapner
The Tatz Group
Healthcare Recruiter
678-725-5752 Cell and Text
*************

Summary

Reporting to the Associate Chief Medical Officer, the Medical Director, Market is an integral part of each mission-driven market team. The medical director's primary responsibilities are to ensure that the clinical processes that contribute to the health plan are high functioning and medically appropriate, including care management, utilization management, health plan operations, quality improvement, and HEDIS. The incumbent will also serve as a critical contributor to network strategy, working with providers on behalf of members and the health plan to ensure best in class outcomes through aligned value-oriented relationships.

What You'll Be Doing

• Work collaboratively with leadership at CCA Health to achieve strategic goals as related to development and implementation of population health and quality improvement strategies, with an emphasis on HEDIS and Stars Metrics
• Works with the enterprise clinical leadership team and the market clinical director to operate consistent and efficient utilization and care management programs, metrics, and reports. Provide medical leadership to UM team members and care managers as needed. Provide oversight of APC licensure as dictated by state of operation.
• Provides medical leadership, consultation, and oversight to the entire team.
• Works with the external stakeholders including local providers, IPAs and ACOs to design models that improve care coordination, care delivery, outcomes, metrics, and accurate HCC coding for value-based contracts as directed by market general manager.
• Act as a clinical ambassador for the work that CCA does when needed to develop new market relationships.
• Participates in credentialing committee activities, utilization management reviews, medical policy committee, and other duties as appropriate.
• In partnership with local market leadership and under the direction of the CMO, responsible for participating in high-level strategic business development, focused on membership growth, retention, network development and identification of opportunities for high value engagement

What We're Looking For

Required

• BC/BE physician
• Has or is able to obtain an unrestricted license in the state of employment
• 5+ years of clinical practice
• Previous experience working in a Health plan or IPA
• Interest and experience in serving patients with complex medical, behavioral, social, and functional needs
• Experience working in interdisciplinary team settings with clinical and non-clinical staff
• Creative problem solver
• Strong interpersonal skills
• Commitment to social justice in medicine and an understanding of healthcare reform
• Effective teaching and mentorship skills
• Ability to lead by influence and work independently
• Excellent communication and presentation skills
• Excellent analytical skills
• Proven ability to collaborate effectively as a part of an interdisciplinary team
• Excellent organizational, time-management skills
• Comfortable with Microsoft Office and Adept with electronic health records.
• Proven skills, knowledge base and judgment necessary for independent clinical decision-making
• Expert knowledge of public payer health care programs (Medicare, Medicaid)
• Expert knowledge of provider reimbursement strategies, in-depth understanding of value-based models
• Demonstrated knowledge and successful track record of health plan operations including utilization and care management, claims processing, contracting and provider relations, and regulatory compliance required.

Preferred

• Primary Care field -- internal medicine, med/peds, family medicine preferred
• Geriatric experience
• MPH, MBA, or MHA welcome, but not essential
• Experience with quality improvement, monitoring and evaluation, working knowledge of health plan functions,
• Previous health plan experience
• Bilingual Spanish or other language