Assistant Medical Director of Managed Care

Company: Community Health Care
Location: Tacoma
Posted on: February 25, 2021

Job Description:

Assistant Medical Director of Managed Care Level Senior Job Location Community Health Care - Hilltop Regional Health Center - Tacoma, WA Position Type Full Time Medical/Professional School Salary Range Undisclosed Travel Percentage Undisclosed Job Shift 8am-5pm; Monday-Friday Job Category Health Care Description JOB TITLE: Assistant Medical Director MD/DO REPORTS TO: Chief Medical Officer SUPERVISES: Physicians, ARNP's, PA-C's, QI Manager, All Medical Programs as Assigned FLSA STATUS: Exempt UNION STATUS: Non-Union JOB OVERVIEW: This position focuses on Directing Managed Care of Community Health Care Clinics with limited responsibility for all clinical services. Functions include clinical management, assisting project administration in the development, strategy and maintenance of health plans, program management, financial outcomes, quality assurance, and public relations. Responsible for building out the supporting infrastructure to appropriately serve all providers with the required practice operations support and delivery of analytic, clinical, and operational resources and services to enable success in a FQHC value-based environment. ESSENTIAL FUNCTIONS INCLUDE BUT ARE NOT LIMITED TO:

• appeals and denials) and provider peer review to help ensure the most appropriate care is provided to the patient population.
• Oversee the establishment of necessary structures and processes to optimize adequate healthcare delivery model within a global risk structure.
• Oversee the establishment and implementation of clinical practice guidelines for Managed Care.
• Develop a depth of knowledge and hands-on experience with operating against value-based arrangements including care management programs and necessary operational infrastructure and programming for managing attributed lives
• Assist with the establishment and implementation in a patient and provider-centric manner to effect change and improve processes and outcomes necessary for primary care providers and care teams to be successful under advanced risk-based arrangements.
• Coordinated with Finance to identifying medical cost trends and participation in medical cost improvement initiatives.
• Assist report writers and QI department with the development and implementation of healthcare operational data and reports by State FQHC and payor value-based outcomes.
• Provide leadership and coordination in collaboration with the Quality, pharmacy, behavioral health, and finance departments for the development and implementation of a cohesive approach to measuring and promoting quality processes for Medicaid Managed Care program quality metrics.
• Build and maintain effective working relationships with cross-functional leaders and teams in order to identify, explore, present and implement Medicaid program opportunities.
• Assist with the medical provider workflow for implementation of the Quality Improvement performance improvement projects in collaboration with QI and finance.
• --Work with the Chief Compliance Officer and Chief Financial Officer to help--oversee the establishment of policies and procedures to ensure contractual compliance and the provision of cost effective and high-quality care and services by CHC.
• Oversee the review and analysis of provider utilization performance; collaborate with Provider care teams to improve outcomes.
• Collaborate with hospital, clinics and the QI and Fiscal departments to ensure efficient management of hospital transitions.
• Serve as the medical professional liaison between Managed Care and providers and CHC to ensure an integrated approach to medical quality; maintain productive relationships with providers.
• Ensure integration with the Accountable Communities of Health (ACH) Community Health Workers (CHW's) and the providers.
• Attend the QI Committee, QI Leadership Committee and Risk Management Committee meetings.
• Ensure provider teams and residents are utilizing the incident reporting system. Participate in root cause analyses as related to serious provider incidents.
• Monitor and analyze emerging trends in the managed care industry encompassing the areas of quality and utilization management, and medical economics; assess the impact and make recommendations for tactical or strategic response. PCMH REQUIREMENTS: Recognizes that the focus of care is the patient and understands patient participation and control of their care is our priority. Maintains focus of agency on the following patient centered principles:
  • Continuous and Team-based Healing Relationships
  • Patient-centered Interactions
  • Engaged Leadership whose focus is the patient
  • Quality Improvement (QI) Strategy that is inclusive and dynamic
  • Enhanced Access
  • Care Coordination
  • Organized, Evidence-based Care Maintains communication between departments and outside agencies and responds to needs of others in a prompt and respectful manner. KNOWLEDGE, SKILLS, and ABILITIES:
    • Ability to communicate effectively verbally and in writing, and utilize good listening skills.
    • Ability to work effectively in a collaborative, team based work environment, including the ability to positively receive and give constructive feedback.
    • Ability to provide high quality patient care and excellent customer service for patients and internal customers.
    • The ability to successfully supervise others.
    • Skills in program development and implementation.
    • Ability to identify and resolve both personnel and patient care issues.
    • Skill in exercising high degree of initiative, judgment, discretion and decision-making.
    • The ability to successfully lead and supervise others.
    • Skills in program development and implementation.
    • High degree and broad base diagnostic skills and knowledge of all aspects of primary care medicine and its delivery.
    • Knowledge of Managed Care systems. Qualifications MINIMUM QUALIFICATIONS:
      • Completed residency in an accredited program and board certification.
      • Eligibility for standard risk management malpractice insurance.
      • Current WA state Medical license.
      • Must possess experience in primary care to include clinical, administrative and direct staff supervisory experience with demonstrated leadership capabilities in prior setting.
      • Current CPR. PREFERRED QUALIFICATIONS:
        • Community Health experience. PHYSICAL REQUIREMENTS: The physical demands listed below are representative of the physical requirements necessary for an employee to successfully perform the essential f unctions of this job. Hearing: Adequate to perform job duties in person and over the telephone. Speaking: Must be able to communicate clearly to patients/customers in person and over the telephone. Vision: Visual acuity adequate to perform job duties, including reading information from printed sources and computer screens Movement: Moderate physical activity. This position requires standing/walking more than 4 hours per day. Also required is some bending, reaching, standing, walking, squatting, and light lifting not exceeding 20 lbs.

Keywords: Community Health Care, Tacoma , Assistant Medical Director of Managed Care, Healthcare , Tacoma, Washington