Medical Director-Hometown Health

  • Requisition ID: HTH MD
  • Department: 510804 Other Administration
  • Schedule: Part Time - Eligible For Benefits
  • Shift: Day
  • Category: First/Mid-Level Officials and Managers

Position Purpose

The Medical Director is one of the health plan's clinical leaders and is responsible for helping to develop and implement health plan policies on patient care facilitation, serving as a medical liaison with contracted physicians, assisting in the oversight of the Quality Management, Case Management, and Utilization Review programs, participating in the credentialing process, and communicating plan policy to contracting physicians. The Medical Director also has clinical oversight responsibilities for the plan products including the Medicare Advantage and ACA plans’ Risk Adjustment Revenue enhancement program. The Medical Director will also be involved in the implementation of the Renown Health System population health strategy in its overlap with the health plan duties and initiatives. The Medical Director is a member of the Hometown Health Leadership team and is involved in the strategy for the plan.

 

 

 

Nature and Scope

Act as the Medical Director of Hometown Health and related entities. Assist in developing and implementing Hometown Health Board-approved policies relating to overall patient care programs. Serve as a clinical leader for the plan’s Quality Management, Credentialing, Risk Adjustment and Utilization Management programs. Said duties shall include, but not be limited to, the following:

• Provide guidance to the Hometown Health leadership as it pertains to activities of Quality Management Committees.

• Provide guidance for clinical operational aspects of the plan.

• Provide guidance for clinical operational aspects of the above programs.

• Has responsibilities for oversight of clinical decision-making aspects of the program. Will have periodic consultation with practitioners in the field.

• Will help ensure the organizational objective to have qualified clinicians accountable to the organization for decisions affecting consumers.

• Help monitor the effective implementation of the Plan’s quality Management programs.

• Provides approximately 40% of dedicated time supporting the organizations quality program and activities in capacities specifically designated by the Quality Management program.

 

In conjunction with the Quality Management Committee, actively pursue the development and maintenance of quality-of-care standards, both in the inpatient and ambulatory sectors.

• Assist in monitoring the results of relevant Quality Management activities and see that these results are communicated to participating physicians. Such information will include both the results of routine monitoring activities, as well as those of problem-oriented studies and analysis, including individual physician performance.

• Provide appropriate follow-up of problems identified through the plan’s Quality Management program.

• Assist in oversight of all clinical aspects of the credentialing programs.

• Act as the clinical lead, in conjunction with the CMO, in leading the Hometown Health Medical Affairs Committee.

• Review all credentialing applications for approval by the Medical Affairs Committee.

Provide direction and support for the clinical utilization review process which includes:

• Support of the Utilization Review Programs of Hometown Health.

• Guidance and support to the Medical Affairs Committee which is responsible for matters pertaining to utilization and credentialing.

• Develop and monitor utilization policies and procedures.

• Communicate utilization issues with providers and provide appropriate follow-up of problems identifies by staff and the Medical Affairs Committee.

Additional Responsibilities include:

• Assist in management for the Medicare Risk Adjustment, chronic condition coding and revenue enhancement program.

• Serve as a member of the HTH strategy and leadership team.

• Assist in the evaluation of and contracting with health care providers and suppliers.

• Assist the plan in analyzing its specialty practice needs and assist in the recruitment of needed physicians.

• Serve as a mediator of potential problems and conflict, both among participating physicians and between physicians and the plan.

• Serve as a physician liaison in the administration of the plan’s enrollee problem resolution procedures.

• Participate in the plan’s budgetary process, particularly as this process pertains to his/her specific areas of responsibility.

• Participate in and facilitate the professional credentialing process (application, privilege delineation, periodic reappraisal, discipline and appeals).

• Provide orientation to new physicians on the plan’s general organizational structure, and policies and procedures. Serve as a liaison between the plan and its contracting physicians.

• Help direct and support all pharmacy programs of the plan.

• Assist in the administration of the chronic condition coding clinic and act as the supervising physician for advanced practitioners requiring supervision.

• The position may require the supervision of advanced practice providers working on behalf of Hometown Health

This position does not provide patient care.

 

 

Disclaimer

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

 

 

 

Minimum Qualifications
Requirements - Required and/or Preferred

Name

Description

Education:

Must have working-level knowledge of the English language, including reading, writing, and speaking English. Medical Degree (MD or DO) from Accredited University.

Experience:

Minimum of five (5) years post graduate clinical practice experience in direct patient care. Experience in the managed care environment which includes significant involvement with utilization and quality management is desired but not necessary for the right candidate. Demonstrated leadership and high caliber medical ability.

License(s):

Must possess and maintain a current and valid State of Nevada Doctor of Medicine (MD) or Doctor of Osteopathic (DO) medicine license.

 

Ability to obtain and maintain a valid State of Nevada driver's license and ability to pass Renown Health's Department of Motor Vehicle Report criteria.

Certification(s):

Board certified and verified by American Board of Medical Specialists

Computer / Typing:

Must be proficient in Microsoft Office Suite, including Outlook, PowerPoint, Excel, Teams, and Word and have the ability to use the computer for online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.

 

 

Benefits

Renown Health exists to make a genuine difference in the health and well-being of the people and communities we serve. And it is through your passion that this mission is made real every day. The relationship with employees is the foundation for success as we proceed with our strategic direction. We strive to build upon this solid partnership by offering a comprehensive and competitive benefits package that meets the diverse needs of employees and their family members.

With my CAREER Rewards there's peace of mind in knowing that Renown Health is also fighting for the most important things in your life - family, finances and future. Navigate options and make sure you are getting the most value from your Nursing career with us.

  • Icon- Edu Assistance@1x

    Education Assistance

  • Icon - PTO@1x

    Paid Time Off

  • Icon - 401@1x

    401(k) Company Match

  • Icon - Flexible Env@1x

    Flexibile Work Environment