Medical Director

Location US-NY-New York
Posted Date 3 weeks ago(2/1/2018 3:23 PM)
Job ID
2018-11321
# Positions
1
Facility
ArchCare Community Services
Category
Physicians
Work Days Per Week
3
Shift
D
Shift Start Time
9:00 AM
Shift End Time
5:00 PM
Type
Part Time
# Hours
21

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 FACIITIES. REPORTS TO THE SENIOR VICE PRESIDENT/CMO ENSURE OVERALL COORDINATION OF BEST PRACTICES FOR CARE TO ENROLLED MEMBERS WITHIN THE PLAN.

Responsibilities

  • WORKS WITH THE EXECUTIVE DIRECTOR TO PROVIDE LEADERSHIP AND VISION TO THE PLAN.
  • ACTIVELY PARTICIPATES WITH SVP/CMO and EXECUTIVE DIRECTOR, TO REPORT ON MEDICAL AND QUALITY ISSUES TO THE SENIOR VICE PRESIDENT 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.
  • EVALUATES AND IMPLEMENTS CLINICAL PRACTICE GUIDELINES BASED ON CURRENT LITERATURE AND SHARED STATE OF THE ART CLINICAL INFORMATION ALONG WITH THE SNP QUALITY AND MEDICAL ADVISORY COMMITTEES.
  • LIAISONS WITH PHYSICIAN 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.
  • WORKS WITH PROVIDER RELATIONS DEPARTMENT TO PROVIDE ORIENTATION AND PERIODICALLY UPDATED TRAINING TO CONTRACT MEDICAL SPECIALISTS AND INTERFACES WITH CONTRACTED SPECIALISTS TO PROVIDE THE GERIATRIC AND SNP PERSPECTIVE AND DEAL WITH CONTRACT PERFORMANCE OR QUALITY CONCERNS IF/WHEN THEY ARISE.
  • 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 ACTIVITES 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 CAREAND OTHER ISSUES APPLICABLE TO THE CLINICAL POPULATION BEING SERVED
  • 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

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.

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