Address
Form of work AdventHealth Corporate
All the benefits and perks you need for you and your family:
• Benefits from Day One
• Career Development
• Whole Person Wellbeing Resources
• Mental Health Resources and Support
Our promise to you:
Joining AdventHealth is about being part of something bigger. It's about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.
Shift : Monday-Friday
Job Location : Hybrid - 3 days at the office
The role you'll contribute:
Reporting to the AdventHealth Population Health Services Organization's (PHSO) Chief Medical Officer, the Senior Medical Director provides a wide range of general medical management services to continuously improve the clinical cost, utilization, appropriate coding and documentation, quality and member service performance of the organization. The Senior Medical Director will interact with the practices and individual physicians within the PHSO networks, payer leadership, customers, and internal and external partners to facilitate this work. The Senior Medical Director will have primary responsibility related to the PHSO credentialing, quality and utilization management programs. The Senior Medical Director will participate in various committees and the strategic planning and budgeting process of the PHSO. The Senior Medical Director will take on greater responsibilities for the operations of the PHSO and will have direct line responsibility for PHSO Medical Directors and other staff within the Medical Management Department. In this role, he / she will have responsibility for budget and human resources functions. It is expected the Senior Medical Director will play a more significant role in the development and execution of PHSO strategy and serve as a member or chair of assigned committees.
The value you'll bring to the team:
PRINCIPAL DUTIES AND JOB RESPONSIBILITIES:
Clinical Analytics
• Assists in the formulation of healthcare service cost and utilization forecasts for selected patient populations and value-based contracts.
• Collaborates with, and advises, the Analytics teams to identify and prioritize clinical cost, utilization, coding and documentation, quality, and member service improvement opportunities.
• Provides medical expertise for the development of physician reports. Payor Contracts
• Reviews and evaluates potential and existing value-based contracts to ensure clinical and medical management components are appropriate and consistent with PHSO programs and strategies.
• Assists in payer negotiations as appropriate, including direct interaction with payers.
• Consults in the design of new payer reimbursement strategies, and in the ongoing evaluation of existing payer reimbursement strategies.
• Meets with payers to identify clinical cost, utilization, appropriate coding and documentation, quality, and member service opportunities, and to develop collaborative improvement strategies and programs.
• Interacts with payers to ensure appropriate care and utilization management systems are in place and optimally performing. Network Management
• Provides internal guidance for the selection or curation of practices and individual providers within the PHSO provider network.
• Meets as requested with practices or physicians being considered for participation in the PHSO network to evaluate and negotiate their inclusion.
• Meets regularly and as needed with PHSO network practices, practice leaders, and / or individual physicians to provide education on the PHSO, review current performance, coach on performance opportunities, and assist in the resolution of various issues.
• Functions as a liaison for clinical issues between network providers and the PHSO leadership.
• Provides medical direction for the PHSO credentialing operations including oversight of the program, review and recommendation of credentialing applications, participation in credentialing committee meetings, and communication of credentialing results to applicants and other stakeholders.
• Provides leadership and management for the PHSO peer review program and facilitates interaction with network providers regarding corrective action plans.Medical Management
• Provides medical expertise to assist, and when assigned, lead the development and implementation of systems and processes to improve and optimize the clinical cost, utilization, appropriate coding and documentation, quality, and member service outcomes of the PHSO.
• Communicates the results of clinical cost, utilization, appropriate coding and documentation, quality, and member service opportunity studies and their recommendations to appropriate PHSO stakeholders.
• Interacts with Clinical Integration Network (CIN) and Accountable Care Organization (ACO) leaders to discuss clinical and operational opportunities for improvement.
• Evaluates, and advises on program opportunities. The scope may include internal interactions with Primary Health Division, Acute Health Division, and AdventHealth Corporate partners and programs, as well as external partner or vendor programs.
• Provides medical expertise and advises on the development, implementation and management of revenue growth opportunities including, but not limited to new value-based contracts, direct-to-employer solutions, clinical bundles, and government programs.
• When assigned, the Medical Director will participate in marketing discussions with potential or existing customers for value-based services.
• Provides medical expertise and advises internal PHSO clinical programs including care management.
• Uses medical expertise to identify and act upon the broad range of factors and conditions that have a strong influence on health to reduce inequities and positively impact social determinants of health among population groups.
• Maintains communication and interacts with stakeholders, leaders, and clinical staff to update them on the PHSO's efforts and performance.
• Ensures compliance of all applicable local, state and federal agencies and regulatory bodies as it relates to medical management. Quality Management
• Collaborates and provides leadership for the PHSO quality improvement program.
• Leads and directs the development and adoption of cost-effective, high quality clinical protocols to appropriately manage risk populations.
• Communicates the PHSO quality program and clinical protocols across the AdventHealth System.
• Collaborates with AdventHealth Information Systems to implement clinical protocols into Epic. Utilization Management
• In collaboration with PHSO and payer leadership, develops, implements, and maintains programs to ensure the appropriate utilization of resources and delivery of high-quality services to manage value-based populations. Senior Medical Director Specific Responsibilities
• Responsible for the development and management of the Medical Management department budget.
• Responsible for the development and management of Medical Management department goals and objectives.
• Responsible for supervision of other Medical Directors and staff within the Medical Management department including the hiring, onboarding, assignment of duties, and coaching and performance improvement of these personnel.
• The Senior Medical Director likely will be assigned some higher profile responsibilities than other Medical Directors might engage. Other
• Presides over or serves on management committees, steering committees, task forces, or other governing boards as required.
• Prepares and presents reports and presentations to the executive leadership as required.
• Participates in strategic planning and the annual budget process.
• Provides management of direct reports.
• Other duties as assigned by PHSO Chief Medical Officer.
Qualifications
The expertise and experiences you'll need to succeed:
KNOWLEDGE AND EXPERIENCE STRONGLY PREFERRED:
• Strong leadership and organizational skills.
• Outstanding collaborative skills with demonstrated ability to work effectively with physicians.
• Skilled at conflict resolution.
• High level interpersonal skills.
• Excellent written and oral communication ability.
• Critical thinking/problem solving skills.
• Excellent coaching skills.
EDUCATION AND EXPERIENCE REQUIRED:
• M.D. / D.O. degree from an accredited program.
• 5 years of clinical experience.
• 2 years of experience in healthcare leadership, preferably at a managed care organization, integrated delivery system, or multispecialty group practice.
• 2 years of experience in direct supervision of other Medical Directors and staff.
EXPERIENCE PREFERRED:
• Experience in the design and implementation of clinical protocols and utilization management/ quality assurance programs.
• Experience in the design and implementation of provider reimbursement systems.
• Experience in network management from a payor and / or integrated payor / provider standpoint.
• Experience in the analysis of clinical information, the identification of improvement opportunities, and the implementation of robust performance improvement methodologies.
• Physician reviewer or utilization management experience. Experience in communication with physicians.
LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:
• Current unrestricted medical license
• Board certification by American Board of Medical Specialties, American Osteopathic Association, or equivalent.
• Once the TPA is in place, appropriate medical licensing based on state requirements will be necessary
All the benefits and perks you need for you and your family:
• Benefits from Day One
• Career Development
• Whole Person Wellbeing Resources
• Mental Health Resources and Support
Our promise to you:
Joining AdventHealth is about being part of something bigger. It's about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.
Shift : Monday-Friday
Job Location : Hybrid - 3 days at the office
The role you'll contribute:
Reporting to the AdventHealth Population Health Services Organization's (PHSO) Chief Medical Officer, the Senior Medical Director provides a wide range of general medical management services to continuously improve the clinical cost, utilization, appropriate coding and documentation, quality and member service performance of the organization. The Senior Medical Director will interact with the practices and individual physicians within the PHSO networks, payer leadership, customers, and internal and external partners to facilitate this work. The Senior Medical Director will have primary responsibility related to the PHSO credentialing, quality and utilization management programs. The Senior Medical Director will participate in various committees and the strategic planning and budgeting process of the PHSO. The Senior Medical Director will take on greater responsibilities for the operations of the PHSO and will have direct line responsibility for PHSO Medical Directors and other staff within the Medical Management Department. In this role, he / she will have responsibility for budget and human resources functions. It is expected the Senior Medical Director will play a more significant role in the development and execution of PHSO strategy and serve as a member or chair of assigned committees.
The value you'll bring to the team:
PRINCIPAL DUTIES AND JOB RESPONSIBILITIES:
Clinical Analytics
• Assists in the formulation of healthcare service cost and utilization forecasts for selected patient populations and value-based contracts.
• Collaborates with, and advises, the Analytics teams to identify and prioritize clinical cost, utilization, coding and documentation, quality, and member service improvement opportunities.
• Provides medical expertise for the development of physician reports. Payor Contracts
• Reviews and evaluates potential and existing value-based contracts to ensure clinical and medical management components are appropriate and consistent with PHSO programs and strategies.
• Assists in payer negotiations as appropriate, including direct interaction with payers.
• Consults in the design of new payer reimbursement strategies, and in the ongoing evaluation of existing payer reimbursement strategies.
• Meets with payers to identify clinical cost, utilization, appropriate coding and documentation, quality, and member service opportunities, and to develop collaborative improvement strategies and programs.
• Interacts with payers to ensure appropriate care and utilization management systems are in place and optimally performing. Network Management
• Provides internal guidance for the selection or curation of practices and individual providers within the PHSO provider network.
• Meets as requested with practices or physicians being considered for participation in the PHSO network to evaluate and negotiate their inclusion.
• Meets regularly and as needed with PHSO network practices, practice leaders, and / or individual physicians to provide education on the PHSO, review current performance, coach on performance opportunities, and assist in the resolution of various issues.
• Functions as a liaison for clinical issues between network providers and the PHSO leadership.
• Provides medical direction for the PHSO credentialing operations including oversight of the program, review and recommendation of credentialing applications, participation in credentialing committee meetings, and communication of credentialing results to applicants and other stakeholders.
• Provides leadership and management for the PHSO peer review program and facilitates interaction with network providers regarding corrective action plans.Medical Management
• Provides medical expertise to assist, and when assigned, lead the development and implementation of systems and processes to improve and optimize the clinical cost, utilization, appropriate coding and documentation, quality, and member service outcomes of the PHSO.
• Communicates the results of clinical cost, utilization, appropriate coding and documentation, quality, and member service opportunity studies and their recommendations to appropriate PHSO stakeholders.
• Interacts with Clinical Integration Network (CIN) and Accountable Care Organization (ACO) leaders to discuss clinical and operational opportunities for improvement.
• Evaluates, and advises on program opportunities. The scope may include internal interactions with Primary Health Division, Acute Health Division, and AdventHealth Corporate partners and programs, as well as external partner or vendor programs.
• Provides medical expertise and advises on the development, implementation and management of revenue growth opportunities including, but not limited to new value-based contracts, direct-to-employer solutions, clinical bundles, and government programs.
• When assigned, the Medical Director will participate in marketing discussions with potential or existing customers for value-based services.
• Provides medical expertise and advises internal PHSO clinical programs including care management.
• Uses medical expertise to identify and act upon the broad range of factors and conditions that have a strong influence on health to reduce inequities and positively impact social determinants of health among population groups.
• Maintains communication and interacts with stakeholders, leaders, and clinical staff to update them on the PHSO's efforts and performance.
• Ensures compliance of all applicable local, state and federal agencies and regulatory bodies as it relates to medical management. Quality Management
• Collaborates and provides leadership for the PHSO quality improvement program.
• Leads and directs the development and adoption of cost-effective, high quality clinical protocols to appropriately manage risk populations.
• Communicates the PHSO quality program and clinical protocols across the AdventHealth System.
• Collaborates with AdventHealth Information Systems to implement clinical protocols into Epic. Utilization Management
• In collaboration with PHSO and payer leadership, develops, implements, and maintains programs to ensure the appropriate utilization of resources and delivery of high-quality services to manage value-based populations. Senior Medical Director Specific Responsibilities
• Responsible for the development and management of the Medical Management department budget.
• Responsible for the development and management of Medical Management department goals and objectives.
• Responsible for supervision of other Medical Directors and staff within the Medical Management department including the hiring, onboarding, assignment of duties, and coaching and performance improvement of these personnel.
• The Senior Medical Director likely will be assigned some higher profile responsibilities than other Medical Directors might engage. Other
• Presides over or serves on management committees, steering committees, task forces, or other governing boards as required.
• Prepares and presents reports and presentations to the executive leadership as required.
• Participates in strategic planning and the annual budget process.
• Provides management of direct reports.
• Other duties as assigned by PHSO Chief Medical Officer.
Qualifications
The expertise and experiences you'll need to succeed:
KNOWLEDGE AND EXPERIENCE STRONGLY PREFERRED:
• Strong leadership and organizational skills.
• Outstanding collaborative skills with demonstrated ability to work effectively with physicians.
• Skilled at conflict resolution.
• High level interpersonal skills.
• Excellent written and oral communication ability.
• Critical thinking/problem solving skills.
• Excellent coaching skills.
EDUCATION AND EXPERIENCE REQUIRED:
• M.D. / D.O. degree from an accredited program.
• 5 years of clinical experience.
• 2 years of experience in healthcare leadership, preferably at a managed care organization, integrated delivery system, or multispecialty group practice.
• 2 years of experience in direct supervision of other Medical Directors and staff.
EXPERIENCE PREFERRED:
• Experience in the design and implementation of clinical protocols and utilization management/ quality assurance programs.
• Experience in the design and implementation of provider reimbursement systems.
• Experience in network management from a payor and / or integrated payor / provider standpoint.
• Experience in the analysis of clinical information, the identification of improvement opportunities, and the implementation of robust performance improvement methodologies.
• Physician reviewer or utilization management experience. Experience in communication with physicians.
LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:
• Current unrestricted medical license
• Board certification by American Board of Medical Specialties, American Osteopathic Association, or equivalent.
• Once the TPA is in place, appropriate medical licensing based on state requirements will be necessary
