• Medical Director

    Location US-NY-New York
    Posted Date 2 months ago(3/25/2018 7:05 AM)
    Job ID
    2018-11321
    # Positions
    1
    Facility
    ArchCare Community Services
    Category
    Physicians
    Work Days Per Week
    5
    Shift
    D
    Shift Start Time
    9:00 AM
    Shift End Time
    5:00 PM
    Type
    Full-Time
    # Hours
    37.5
  • Overview

    Responsible for the oversight of the delivery of member care, clinical outcomes and the implementation and oversight of the quality assessment and performance improvement (QAPI) plan. Serves as the lead in design of the medical components of the program and as liaison to the medical community on behalf of ArchCare Advantage. Reviews the outcomes and utilization patterns of the primary care physicians, nurse practitioners and on call physicians and acts in a consulting role as needed. Oversees the relationships with contracting medical specialists and inpatient services at contracted acute and long term care facilities. Reports to the Senior Vice President/CMO to ensure overall coordination of best practices for care to enrolled members within the plan.

    Responsibilities

     

    • Works with the Vice President to provide leadership and vision to the plan.
    • Actively participates with the SVP/CMO and Vice President to report on medical and quality issues to the SVP of Finance and governing authority on a regular basis.
    • Ensures compliance with all CMS regulations and applicable NYS regulations as they pertain to medical, quality and utilization review components of care.
    • Participates, along with other medical directors in the design and implementation of system-wide clinical strategy and protocols.
    • Liaisons with physicians groups, specialists, hospitals and nursing homes to represent the plan. Provides leadership and expresses the needs and abilities of the program in a way that solves day to day problems and communication issues and thereby enhances care of members and the contract relationship.
    • Provides oversight and consultation to primary care physicians, nurse practitioners and pharmacy consultants through case review, analysis of aggregate data, development of internal standards of practice and reviews of program and individual outcomes and indicators.
    • Evaluates and implements clinical practice guidelines based on current literature and shared state of the art clinical information along with SNP quality and medical advisory committees.
    • Provides leadership and oversight to quality assessment and performance improvement process for plan including leadership of applicable committees.
    • Participates in the management of the plan including the development of policies and procedures, active participation on various committees and workgroups, budget preparation and strategic planning.
    • Keeps abreast of federal outcomes based quality improvement activities and geriatric standards of care. Keeps up to date on issues pertinent to chronically ill populations, hospice and end of life issues, pain management standards, managed care and other issues applicable to the clinical population being served.
    • Works with the provider relations department to provide orientation and periodically updated training to contract medical specialists and interfaces with contracted specialists to provide geriatric and SNP perspective and deal with contract performance or quality concerns if and when they arise.
    • Works with the UM Team to ensure that all service determinations are based on members medical need and meet all applicable Interqual, CMS and DOH requirements/regulations.

    Qualifications

    Education Requirements

    • MD Degree

    License Requirements

    • Licensed to practice medicine in the state of New York

    Experience Requirements

    • Minimum of 5 years of experience in Medical Practice, including at least 1 year of geriatric practice

    Experience Desired

    • Previous experience working with an interdisciplinary team and performing comprehensive geriatric assessments
    • Previous experience in managed care administration

    #CB 

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