Assistant Medical Director of Managed Care
Company: Community Health Care
Posted on: February 25, 2021
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
- Oversee the establishment of necessary structures and processes
to optimize adequate healthcare delivery model within a global risk
- 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
- Collaborate with hospital, clinics and the QI and Fiscal
departments to ensure efficient management of hospital
- 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
- Continuous and Team-based Healing Relationships
- Patient-centered Interactions
- Engaged Leadership whose focus is the patient
- Quality Improvement (QI) Strategy that is inclusive and
- 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
- 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
- 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
- Completed residency in an accredited program and board
- Eligibility for standard risk management malpractice
- 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
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