Ambulatory Market Medical Director (Part-Time Administrative)

Adventist Health and Rideout is actively seeking a Market Medical Director to provide professional medical direction services including, but not limited to, implementing, maintaining and refining approved quality assurance/utilization management programs. Maintains current knowledge on and ensures compliance with federal and agency regulations for managed care programs. Participates in network development, contracting, and credentialing in local and regional markets. Supervises and directs the activities of various levels of assigned personnel using both professional and supervisory discretion and independent judgment.

JOB REQUIREMENTS

· Minimum Education: Completion of a recognized course of study such that s/he is a lawfully licensed provider in the State of California.

· Master's Degree in business administration, management, health care management, or related field: Preferred Minimum Work Experience

· Seven years' technical experience: Preferred

· Three years' management experience: Required

· Clinical practice and experience in the development and management of utilization review and quality assurance programs or equivalent relevant experience/education: Required

· Board certified in practice specialty: Required

· Refer to the Required Licenses and Certifications list for additional job and/or unit specific requirements.

· Part-time clinical and administrative role

· Practice experience is preferred

· Ties to the local market/region is preferred

ORGANIZATIONAL EXPECTATIONS

Adheres to the Adventist Health Mission, Vision and Values statements. Complies with behavioral standards, policies, procedures and handbooks established by the organization and their respective ministries. Abides by the guiding principles of the Code of Conduct.

ESSENTIAL FUNCTIONS

Manages functions of Quality Assurance/Utilization Review Committees. Exercises independent judgment in recruiting, training, coaching, supervising and responsibly directing assigned staff. Identifies utilization review studies and evaluate adverse trends in hospital utilization, unusual provider practice patterns, adequacy of benefit/payment components and comparative differences in utilization trends by HMO and PPO providers. Provides medical expertise with respect to planning and establishing goals and policies to improve medical management. Works collaboratively with member services, medical services, provider relations and the executive director to prepare, deliver and encourage implementation of recommendations to provider member for actions which would improve utilization. Participates in the review and assessment, and provides advice on, complex, controversial and/or unique claims which are outside the realm of medical policy. Solicits and evaluates advice of outside medical consultants and physicians with respect to complex or controversial claims or experimental and innovative techniques. Participates in provider network development and new market expansion as appropriate. Participates in the review, assessment and negotiation of provider contracts as appropriate.

· Collaborates with the executive director in development and implementation

· Represents the outpatient medical services on ad hoc committees as appropriate; interface with the provider community regarding medical review, utilization review and quality assurance issues and concerns

·Performs other job-related duties as assigned​