The Regional Medical Director will build creditable and trusting relationships with stakeholders regarding performance metrics. Serve as liaison for the health plan to ensure that all the opportunities are highlighted through detailed reporting to the leadership at the groups. Individually own and lead HBR initiatives that ties to cost savings to the AOP for department. Serve as the clinical lead with large employer groups in the bid process.
- Manage assigned departments or functions with an emphasis on execution, outcomes, continual improvement and performance enhancement.
- Maintain relationships with key employer groups, physician groups, individual physicians, managed care organizations, and state medical associations and societies.
- Participate in quality improvement programs to assure that members receive timely, appropriate, and accessible health care.
- Provide ongoing compliance with standardized systems, policies, programs, procedures, and workflows.
- Analyze member and population data to guide and manage program direction such as ensuring that members enroll in clinical programs indicated by their clinical need and monitor performance.
- Participate in the administration of medical management programs to assure that network providers deliver and Plan members receive appropriate, high quality, cost effective care.
- Assure compliance with all regulatory, accreditation, and internal requirements and audits.
- Articulate plan policies and procedures to providers and organizations and works to ensure effective implementation of policies and programs.
- May serve as a member on quality and/or care management programs and committees as directed.
- Graduate of an accredited medical school
- Doctorate degree in Medicine and Surgery
- MBA, MPH, or epidemiologist degree preferred
- 5+ years of experience Managed care, experience with all LOBs, human resource, leadership capabilities; practice of medicine
- 3+ years of supervisory/management experience
- Current state’s MD license and specialty board certifications
- *Excellent influence and presentation skills
- *Specialty in geriatrics/internal medicine or palliative care!
- *Knowledge of the unique needs of the California Central Valley population!
Healthcare recruitment focused on Psychiatrists, Physicians and IT.
Role: Regional Medical Director (Medi-Cal/Medicare)
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