This Medical Director position in the Medical Value Initiatives Department is primarily responsible for:
1. Providing clinical leadership and support to our medical value strategy initiatives
2. Collaborating with and providing clinical leadership to our affiliates
3. Supporting the sales team in relationships with potential and existing employer group customers
4. Leading and supporting initiatives that drive quality and HEDIS improvements.
This role requires close cross-functional collaboration with other departments within our client to achieve organizational goals around improving member health, experience of care, and medical costs.
1. Responsible for providing clinical leadership and support to medical value strategy initiatives, including, but not limited to, accountable care arrangements, quality incentive programs, and other value based reimbursement programs / strategies.
2. Represents our partner in engagements with external providers; interfaces and develops strong working professional relationships with these partners and ensures understanding of and addresses questions relating to the health of their population.
3. Works directly with the network providers and internally with the Value Based Initiatives department, among others, to champion provider practice transformation in support of our value based delivery models. Reviews and analyzes data to drive that transformation in improving member health, experience of care, and medical costs.
4. Collaborates with and provide clinical leadership and direction to affiliates, particularly around care management programs and the Provider Services Organization (PSO) as they relate to the business.
5. Supports the sales team in relationships with potential and existing employer group customers, participating in clinical presentations to current employer group customers and discussing our clinical programs in finalist presentations.
6. Participates in sales and marketing activities to assist in generating new accounts and maintenance of present accounts.
7. Develops proficiency with the data, reports, and analytics tools used to support our provider partners in value based programs and our employer group customers.
8. Addresses and responds to clinical requests from our provider partners and employer group customers around their data. Ensures our partners / customers are provided timely, accurate, relevant, and actionable information.
9. Provides clinical support to initiatives that drive HEDIS improvements. This would include targeted efforts to not only improve our accreditation status and associated HEDIS, CAHPS, STAR, and HOS results, but to also work collaboratively and cross-functionally across the company to raise awareness of current status and drive improvement projects being implemented and/or that are already in place to optimize plan performance.
10. Collaborates with local area medical leaders as needed and requested.
11. Provides clinical input and/or research regarding best practices in the areas of medical value and value based reimbursement.
12. Serves as a clinical committee representative / chair as needed and requested by the Senior Medical Director
13. Collaborates cross-departmentally in the development and promotion of our medical value mission, vision, and programs in the local medical community and within the State
14. Communicates medical value activities with internal stakeholders and external customers
15. Performs other related duties and assignments as requested and directed
Knowledge of current and emerging medical trends, especially around value based reimbursement and population health
Ability to effectively multi-task under pressure, meet deadlines, and deliver high quality work.
Ability to move from broad strategic perspective to tactical implementation and translate thoughts into actionable plans.
Demonstrated excellent public speaking and written communication skills; experience in creating and presenting oral and written proposals and presentations.
Sound statistical and analytic skills.
General relevant computer skills, including Microsoft Word, Excel, ACCESS, PowerPoint, and Project.
Solid organizational skills and problem-solving ability.
Respect for details and ability to accurately execute them at a high level without excess supervision.
Collaborative approach and respectful relationship style.
A minimum of five years clinical experience, post residency, including both inpatient and outpatient care.
Minimum of three years’ experience in a management or leadership position in the health care industry.
PC literacy and ability to perform electronic research and respond to electronic requests.
Education, Certification, and Licenses:
Minimum requirements include an MD or DO Degree, as well as current Board Certification.
Current unrestricted licensure in Pennsylvania as an MD or DO.
Currently covered by, or eligible to be covered by, medical liability insurance.