Interim Executive Medical Director
Share
Job Location:
Portland, TX - USA
Monthly Salary:
Not Disclosed
Posted on:
17 hours ago
Vacancies:
1 Vacancy
Job Summary
Department Overview
Health Services functions and an MSO and oversees the OHSU Health IDS and OHSU Health CIN. The IDS is a fully capitated Medicaid plan with 61k members. The CINholdsMSSP ACO and other VBC contracts and manages the operations and oversight of those VBC contracts.
This interim position isestablishedto provide critical continuity and stabilization for the Health Plan Servicesteam during a period of physician leadership transition. This role is intended to provide physician leadershipfor clinical operationalcomplianceand strategic initiatives and processes. This leader will also play a keyrole in working with the Health Plan Services leadership team to evaluate and update the future physicianleadership needs of Health Plan Services in terms of titlescopeand FTE. Within 90 to180 days (about 6 months) the findingsof the physician leadership evaluation will be operationalized though the posting of one or more permanent
positions.
The Interim Medical Director Health Plan Services is a senior executive responsible for leading the clinicalperformance and partners with the CAO on the development of the strategic direction of the high performingNetworksthat are foundational to the OHSU Health IDS andTualityHealth Plan Services (THPS). The InterimMedical Director partners with the Chief Administrative Officer (CAO) Health Plan Services together they
are responsible forensuring operational excellence and strategic finetuningaimed at improving the qualityefficiency and financial sustainability of care delivered via OHSU Health networks as measured by well- established clinical quality (HEDIS Stars etc.) and financial metrics (loss ratios percent of premium targetsetc.). Health Plan Services will serve as a Management Services Organization (MSO) supporting value-basedNetworksaffiliated with the OHSU Health System.
The Interim Medical Director will work collaboratively with OHSU Health system leadership in developinghigh performing networks for Medicaid Commercial Medicare Advantage and/or Direct to Employerrelationships that improve the health status of those populations in sustainable economic models andpartnerships that support care transformation. Collaboration with payors and across the organization to achieve OHSU Healthsobjectiveswill be critical. Linking payer and provider network initiatives with those of the Office of Primary Care & Population Health will also be essential to support OHSUs focus on the quadruple aim (improved quality and consumer experience reduced cost increased provider satisfaction).
The Interim Medical Director also provides the executive clinical leadership necessary to advance OHSUs Clinically Integrated Network (CIN). This roleis responsible foraligning clinical strategy with operational goals ensuring federal regulatory compliance for the Medicare Shared Savings Program (MSSP) and driving the last mile of value-based contracting. The Interim Medical Director and CAO willbe responsible forworking with leadership to set meeting agendas present content and to develop programs to provide MSO services enhance quality and assure clinical integration of the IDS THPS and other value-based networks within OHSU and with Payors as applicable. Responsible for working with the Office of Payor Strategy and OHSU Health System leadership to achieve mutual goals as well as withthe HealthShare of Oregon Coordinated Care Organization and state-level workgroups and committees.
Function/Duties of Position
Payor strategy and health plan relationships
- Works CAO and OHSU Leadership teams to understand trends in the marketplace and create responses to those liaison between OHSU Health System and community providers
- Acts as liaison with Health Plans and Insurance company Medical Directors whenappropriate. Participates actively with the physicians of the plan andwith other organizations to achieve mutual goals of the managed caremarketplace.
- Works closely with appropriate payor partners in joint operation of the Medicaid IDS THPS and other networks as applicable.
- Supports OHSU Health in value-based contracting and improvements in risk-based infrastructure and data-driven technology.
- Maintains an in depth understanding of healthcare trends especially concerning value-based networks academic medical centers roles inpopulation health and care transformation serving communities.
Value-based contract Management and Performance
- Responsible for the development and operation of comprehensive management services necessary to efficiently operate OHSU Healths value-based networks including Clinically Integrated Networks risk-based IDSMSSP Direct-to-Employer and other value-based networks. Responsibilityincludes collaboration and leadership with payor partners providing
- some/all management services to OHSU networks (for example ModaHealths management services to the IDS serving Health Share).
- Provides leadership and management for the development of OHSU value- based network strategies and implementation including care management utilization management and pharmacy management programs. Coordinates program activities with the physician committees.
- Supports innovation and process improvement by identifying best practices from across the country and incorporating them into OHSUs value-based networks.
- Oversee the clinical definitions within VBC contracts ensuring that quality metrics and appropriateness targets are sustainable protective of provider well-being and drive shared savings.
- Make medical necessity decisions as required for referrals and pre-authorizations.
Provider network
- Collaborate with the CAO to ensure that the health plans financial objectives are achieved through clinically sound strategies.
- Communicates OHSU Health Plan Operations goals objectives and policies to the physician members in a wide variety of specialties of the applicablevalue-based networks and boards
- Oversees credentialing process for Health Plan Operations and appointment to the applicable value-based network panel to assure compliance withpolicies and procedures. Coordinates these activities with other OHSUdepartments and payors as necessary to ensure OHSU Health providers arecredentialed and appropriately added to OHSU value-based networks in atimely manner.
- Assess quality and appropriateness of care provided by providers in OHSU value-based networks and respond accordingly.
- Able to foster leadership in the OHSU Health network actively reinforcing the positive aspects of quality improvement activities.
Required Qualifications
- MD or DO from an accredited School or Medicine or School of Osteopathy
- Five or more years of physician management experience including any combination of the following: health plan operations/leadership and/or Integrated Delivery Systems including population health value-based care delivery chronic care or other clinical care improvement program development which demonstrates leadership skills with an emphasis on a collaborative style.
- Maintains Oregon medical licensure
- Maintains active courtesy affiliate or honorary staff membership in good standing with the medical staff of the hospital with all privileges and responsibilities accorded such membership
Job Related KnowledgeSkills and Abilities(Competencies):
Demonstrated leader with expertise in caring for diverse and specialty patient populations within complex healthcare systems.
Recognized for strong interpersonal and communication skills with the ability to engage effectively across diverse cultural backgrounds and navigate both routine and high-stakes situations with patients families physicians and interdisciplinary teams.
Proven ability to build credibility and collaborate successfully with physicians in solo and group practices as well as with executive leadership Boards of Directors administrators and business leaders. Experienced in delivering effective presentations to small and large audiences.
Exceptional leadership and management capabilities with a track record of building and guiding high-performing teams in dynamic environments.
Strong analytical organizational and strategic planning skills including experience in data analytics EMR systems healthcare technology and standard business tools.
Comprehensive knowledge of Medicare Medicaid and the Oregon Health Plan with an understanding of healthcare budgeting utilization management and chronic care protocols.
Effectively represents OHSU Health System in local and national forums demonstrating professionalism strategic insight and organizational stewardship.
Preferred Qualifications
- Masters degree in business administration healthcare administration public health or similar field
- Background in medical case management
All are welcome
Required Experience:
Director
Key Skills
- EMR Systems
- Post Residency Experience
- Occupational Health Experience
- Clinical Research
- Managed Care
- Primary Care Experience
- Medical Management
- Utilization Management
- Clinical Development
- Clinical Trials
- Leadership Experience
- Medicare
About Company
OHSU treats the most complex health needs in the region, makes discoveries that save lives and educates next-generation health professionals.
