Medical Director

Job Title: Medical Director

Location: Position needs a Massachusetts Medical License, but person can sit anywhere in US.

Type: 1 year contract, Ad hoc basis

NOTE: This position would only be needed if one of our LTSS Medical Directors could not cover for the other.

This could be in case of PTO, medical leave, unforeseen circumstances. We would like for someone to learn the LTSS case review process in case one of our LTSS Medical Directors is not available. This would be ad hoc only. It would be a position more akin to having a contracted LTSS Medical Director in the wings in case they are needed. This position would require approximately 5 weeks throughout the year.

Description:

Responsibilities for a Medical Director include:

-Performs daily review of home and community-based services to approve or deny appropriate services for members. Will work with nursing staff to clarify requests and documentation as needed

-Represents the health plan in Board of Hearing cases

-Responsible for appropriate utilization management including managing/monitoring the results of Care Management/ Health services interventions to ensure that utilization goals are achieved; collaborating with Care Management/ health services/behavioral health as necessary to maintain focus on achieving targets.

-Works toward fully integrated clinical model working with Behavioral Health and clinical management

-Supports all clinical quality initiatives and peer review processes

-Collaborates with the health plan Chief Medical Officer, and other clinical staff as a clinical resource and coach to support programs and health plan goals

- Collaborates with the Chief Medical Officer, clinical operations staff, and other market staff to support and meet market and national clinical operations goals.

-Accountable for providing clinical leadership primarily focusing on home and community-based services review and external communication with network physicians

-May assist in the development and implementation of local plan clinical policies and procedures, quality improvement activities and performance improvement projects

Qualifications:

- Active/unrestricted Licensed physician

- Board Certified in an ABMS or AOBMS specialty

- 5+ years clinical practice experience; strong knowledge of managed care industry and the Medicaid line of business.

- 2 - 3 years Quality management experience

- Familiarity with current medical issues and practices

- Strong leadership skills as demonstrated by continuously improved results/team building, and effectiveness in a highly matrixed organization

- Excellent interpersonal communication skills

- Superior presentation skills for both clinical and non-clinical audiences

- Proven ability to develop relationships with network/community physicians and other providers

- Excellent project management skills

- Solid data analysis and interpretation skills; ability to focus on key metrics

- Strong team player and team building skills

- Strategic thinking with proven ability to communicate a vision and drive results

- Solid negotiation and conflict management skills

- Creative problem-solving skills.

- Proficiency with Microsoft Office applications