MEDICAL DIRECTOR CARE MANAGEMENT – Florida
The Care Management Medical Director will work closely with the existing team of talented physician executives in helping to define and articulate the clinical leadership and innovative strategies of this dynamic organization. The Medical Director is responsible for providing clinical support and direction for member and provider specific programs. The Medical Director will be responsible for making medical necessity and other benefit coverage determinations in compliance with medical policies, protocols, product designs, and professional judgment. She/he will routinely interface with other teams such as medical policy, pharmacy, network and sales to develop innovative, clinically appropriate benefit designs and services. The Medical Director will also collaborate with local area medical leaders as needed and assist with the development of provider networks and partnerships.
The Medical Director reports to the Senior Medical Director, a seasoned physician executive with a calm demeanor, analytic mind and approachable, team-oriented management style.
ADDITIONAL ESSENTIAL FUNCTIONS:
-Conduct care coordination activities including case management and disease management.
-Conference regularly with care coordination teams to review census and high priority cases and trends.
-Work collaboratively with facility coordinators and case managers to prioritize interventions and work load.
-Initiate peer-to-peer contact for high priority cases to discuss benefit options.
-Lead and support clinical projects as required.
-Interact routinely with Field Medical Directors to discuss trends in local delivery system and support resolution of issues.
-Monthly review and presentation of utilization metrics to Care Management team.
-Participate in governance through committee attendance; chair committees as needed under delegation of the Senior Medical Director.
-Make recommendations for clinical product and program development and identify opportunities for improvement of clinical outcomes.
-Maintain and develop relationships with key thought and business leaders in the health care delivery marketplace.
-Knowledge of health benefits industry, products, trends, consumer market, competitive intelligence, and legislative climate with a minimum of 2 years in an administrative role
-Strong analytic and problem solving skills
-Innovative thinker with ability to manage projects and drive program development
-Understanding and proficiency in use of metrics and measures in managing programs and services
-Skilled in negotiation and conflict resolution. Ability to influence others, accept alternative viewpoints and reach consensus when appropriate
-Commitment to high service standards and a passion for making positive changes within the organization and the healthcare system
-Works collaboratively and encourages cross functional thinking
-Recognizes complexity of managing the needs of multiple customers (plan sponsors, members, providers, brokers and consultants) and proactively identifies those needs
-Highly organized and prioritizes multiple tasks with impeccable follow through
-Exceptional presentation and communication skills
-M.D. or D.O. with active, unrestricted medical license with the ability to obtain Florida Medical Licensure
-Current Board Certification in an ABMS recognized specialty — primary care preferred
-MBA, MPH, MHS, MHA, etc. preferred
For additional information and/or confidential consideration, please contact:
CONSULTANT: Tricia French, RN, BSN
President & CEO
The French Group