Health Plan Medical Director
Adventist Health is hiring a Health Plan Medical Director. This role provides physician leadership in the development, implementation and supervision of Care Management. Maintains responsibility for clinical decision making and quality oversight, along with peer to peer discussions as necessary. Supervises and directs the activities of various levels of assigned personnel using both professional and supervisory discretion and independent judgment.
This role is based in Roseville, CA.
Ensures proper utilization of resources for members and other contracted partners in accordance with the Benefits Administration Care Management Plan. Supports preventative care, wellness initiatives and nutritional services which support care management philosophy of whole person care. Leads with an operational focus, setting strategy, objectives and policies.
Follows all Health Insurance Portability and Accountability Act (HIPAA) compliant policies and processes adopted by the Benefits Administration, including applicable laws and regulations, Fraud Awareness and the use of organizational approved web sites. Assesses, implements and evaluates growth opportunities with new and existing employer groups.
Ensures ongoing quality improvement as it relates to the Care Management program, utilization management, supervision of the clinical pharmacist(s), pharmacy technician(s), other clinicians and support staff. Ensures care provided is medically necessary and is provided in the most cost effective manner and setting. Promotes member engagement and responsibility for their own health outcomes. Prepares department(s) budgets and recommends for approval.
Interacts with physicians and other medical staff as needed to ensure appropriate care for members. Provides supervision of clinical pharmacist(s), pharmacy technician(s) and support staff. Coordinates supervisory duties with the Care Management Manager(s) for other members of the team including nurses, behavioral health specialists, dietitians and support staff. Assumes personal responsibility for professional development. Understands and follow changes in industry standards and laws around health care.
Medical Degree from an accredited University: Required
Master's Degree in business administration, management or health care management: Preferred
Seven years' administrative experience within a medical group practice, hospital structure or other administrative/leadership setting, or related experience: Preferred
Five years' leadership experience: Preferred
Business development and planning experience and post-graduate clinical practice experience: Preferred
Medical Degree (MD) or (DO) and currently licensed to practice, without restriction, in the State of California: Required
Board certification in a primary specialty: Preferred