Medical Director

<p>We are looking for the best and the brightest problem-solvers who are dedicated to changing the way health care is delivered and are passionate about creating a better model for our national health care system. We offer a professional working environment, competitive salaries and excellent benefits. As we continue to grow, we are seeking an experienced Medical Director to join our Detroit, Michigan, office.</p>

Detroit, MI

Healthcare Company

Our task is to make sure that you and your eligible family members are enrolled and receiving Medicaid or Alliance Benefits. Our mission is to help our D.C. neighbors receive the care and services needed to lead a long and healthy life.

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Competitive Salary & Benefits

Overview: Under the direction of and in collaboration with the Chief Executive Officer, the Medical Director is the lead clinician in charge of all aspects of medical care services provided by Harbor Health Plan. Working from a solutions-oriented approach, the Medical Director monitors clinical performance to ensure medical services and operations are in compliance with all applicable accreditation, regulatory and licensing agencies. As a member of the Executive Management team, the Medical Director is responsible for activities related to utilization management, care management, disease management, credentialing and behavioral health integration. Additional responsibilities include being the primary contact for Harbor's after hours, chairing the utilization and credentialing committees, developing and implementing performance objectives, productivity benchmarks, compliance measures, etc. The Medical Director will represent Harbor HP at required State meetings and those with affiliated agencies and in the community.
Responsibilities: <ol> <li>Participates as key member of the organization's Executive Management Team (ET) to develop and maintain a strategic plan for the controlled growth, expansion, and/or development of clinical programs and wellness sites for Harbor; solve existing and anticipated organizational problems; and formulate and/or revise policies that will enhance the achievement of the organization's goals. Attends all ET meetings with the overriding and ongoing goal of integrating clinical and non-clinical aspects of Harbor's operations and services.</li> <li>Responsible for the direct supervision of the Senior Director, Clinical Operations. Sets the direction for their areas of responsibility to align with the overall organizational and clinical division goals.</li> <li>Participates in appropriate Michigan Department of Health and Human Services (MDHHS) committees, programs and activities.</li> <li>Represents Harbor on the Michigan Quality Improvement Consortium (MQIC) Medical Directors Committee in the review and development of clinical practice guidelines.</li> <li>Is responsible for working collaboratively and strategically with the Provider Services area to assure maintenance of standards among the providers in the practice of quality care and the delivery of an appropriate and adequate provider network. Participates in the design of provider incentives and value-based purchasing programs to maintain high quality of care for members. Assists in the resolution of provider issues/complaints.</li> <li>Assists Member Services with the resolution of provider issues affecting member satisfaction and/or the quality of care and member complaints.</li> <li>Manages administrative responsibilities such as budget/finance management, recruitment and development of qualified personnel. In collaboration with the Senior Director, Clinical Operations and other Harbor management, uses a solutions-oriented approach to solve personnel issues in a timely manner including performance failures and violation of standards of care or personnel policy.</li> <li>Ensures clinical operations are in compliance with all applicable accreditation, regulatory and licensing agencies. Assesses all matters of compliance and provides timely recommendations for corrective action and quality improvement.</li> <li>Coordinates with the Director, which has overall responsibility for supervision of the QA&amp;I program, ensuring that quality and appropriateness of care are monitored and that appropriate actions based on monitoring results are taken. The Medical Director is responsible for removing barriers to achieving quality in medical care and for reporting to internal and external committees and entities, as required.</li> <li>Establishes and/or maintains working and collaborative relationships in the health provider community, on behalf of and in accordance with the formal understandings of HHP. Develops relationships with hospitals, practitioners, specialty providers and ancillary services for provision of care, seeks out available medical resources, and secures medical access for HHP patients.</li> <li>Represents HHP to consultative and advisory bodies and to collaborating agencies, as requested; participates in meetings, conferences, etc., on behalf of HHP and to further collaborative efforts with these organizations.</li> <li>Provides leadership, vision, and direction in developing new clinical programs for HHP; directs, monitors and evaluates programs, revising and adapting as necessary and/or appropriate; assists in formulation and/or revision of medical program/clinical services policies and protocols.</li> <li>Responsible for the Utilization Management Program including review of prior authorization requests for medical necessity, clinical criteria for decision-making, and appeals. Reviews key metrics to determine the effectiveness of the program. Meets on an ongoing basis with staff to review inpatient cases. Assists in the management of complex cases requiring extensive medical resources.</li> <li>Responsible for Case Management and Disease Management programs to include the integration of behavioral and physical health.</li> <li>Provides clinical oversight of HHP's Credentialing Program.</li> <li>Chairs and develops the agendas for the Utilization Management, Pharmacy and Therapeutic as well as Credentialing Committees.</li> <li>Primary contact for Harbor's after hours.</li> <li>Maintain a high level of professional and technical knowledge required to provide leadership and responsibilities of the position and HHP to include but not limited to, continuing education, professional publications, participation in professional societies, etc.</li> </ol> <p>&nbsp;</p>
Requirements: <p><strong>EDUCATION AND EXPERIENCE:</strong></p> <ol> <li>Board certification, or Board eligible, in a major primary care specialty field of practice.</li> <li>5 years clinical experience in a direct clinical practice.</li> <li>Minimum three year's experience in progressively responsible administrative or management-related positions within a health plan or managed care environment.</li> <li>Strongly prefer two year's previous experience as medical director or associate medical director with a Medicaid patient population.</li> </ol> <p><strong>QUALIFICATIONS:</strong></p> <ol> <li>Current, valid, unrestricted license to practice medicine in the State of Michigan.</li> <li>Unrestricted Pharmacy license in the State of Michigan.</li> <li>Unrestricted DEA license.</li> <li>Demonstrated ability to work effectively independently and as part of a team, in collaborative settings, required.</li> <li>Excellent written and verbal communication skills required.</li> <li>Demonstrated ability to provide leadership to staff and to build the trust and respect of members, staff, colleagues, external contacts, and other ET members.</li> <li>Excellent problem-solving skills required, including creativity, resourcefulness, timeliness, and technical knowledge related to analyzing and resolving medical/administrative problems.</li> <li>Demonstrated ability to utilize computer technology.</li> </ol>