What are the responsibilities and job description for the REMOTE - Vice President Medical Director of Clinical Programs position at Martin's Point Health Care?
Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.
Position Summary
Job Description
Key Outcomes:
- Achieves defined clinical outcomes, affordability goals and growth targets, in partnership with HP SLT, to accomplish HP strategy, quality and cost containment
- Works closely across the HP to ensure compliance with government program regulations, including management of clinical appeals and grievances with sound clinical evidence and advice
- Works closely with the Medical Directors and the Director of Medical Economics to devise analytic approaches that support and measure strategic development and sound clinical programs
- Provides clinical insight into data to assist in development of and measurement of tailored interventions that address clinical trends and opportunities
- Develops key strategies to address opportunities in medical expense management
- Identifies opportunities for improvement in the quality of care that create competitive advantage for Martin’s Point as it relates to the health of populations served
- Accountable for appropriate Utilization Management processes including sound partnership and collaboration between the UM/CM team and the Medical Directors to ensure High performance of team members that drive the right services at the right place and time for our health plan members
- Assists and provides clinical input into the evolution of care/utilization management, quality, and pharmacy related programs
- Contributes to and advises in product design and the Medicare bid processes
- Contributes to and advises in areas of clinical integration as it relates to risk adjustment
- Serves as a central HP leader aligning medical, clinical, and operational functions to achieve seamless and thorough solutions related to Medical and Payment Policies
- Actively engages with quality, network, and compliance teams to help drive performance
- In collaboration with the MPHC Chief Medical Officer (CMO), advocates with government/state regulatory entities, professional and medical society chapters, federal regulators/contactors, and as part of external communications and media relations to advance HP’s clinical value story, evidence-based medical policies, and member health
- Provides subject/specialty-based clinical expertise and leadership to Clinical Programs and other areas of MHPC, as needed
- Assists the Market Medical Director for building and deepening relationships with area hospitals, physicians, and other health care providers in support of the Quadruple Aim
- Assists in creating a cohesive, network engagement strategy and reporting capability that supports iterative improvements in performance to population health and care management goals that are specifically tied to contractual agreements
Education/Experience:
- Medical Degree (MD or DO) from accredited medical school
- At least 5 years of experience to include several years of clinical practice, including a leadership role and Health Plan experience as a Medical Director
- HMO/Managed Care experience, including Utilization and/or Quality Program management and exposure to peer review, case management, population health, appeals, chronic and complex disease management, HEDIS reporting, and provider relations
- Experience with STARS and RAF in a Health Plan space preferred
- Government sector experience preferred (Medicare, Medicaid and or Military/Tricare products)
- Prior Management experience preferred
Required License(s) and/or Certification(s):
- Board Certification in relevant discipline or specialty
Skills/Knowledge/Competencies (Behaviors):
- Excellent interpersonal communication and problem-solving skills and ability to influence in executive settings
- Proficient with Microsoft Office applications (Outlook, Word, Excel, PowerPoint)
- Accustomed to and comfortable with continuous change/ambiguity
- Strong communication and presentation skills; ability to tailor message to a variety of audience levels; proven presentation skills for both clinical and non-clinical audiences
- Strong analytic skills with proven understanding of health care utilization data and analytics
- Able to make data-driven decisions, implement solutions and document measurable impact. Data skills include the ability to design tracking reports for clinical and financial metrics
- ability to develop relationships with network and community physicians and other providers
- Demonstrates an understanding of and alignment with Martin’s Point Values.
- Deep knowledge and practical understanding of healthcare systems and managed care concepts.
- Able to educate and promote best practices within medical and clinical care programs
- Knowledge of performance-based HP/provider arrangements.
- Strong analytic skills with the ability to identify meaningful trends and targets for improvement.
- Excellent interpersonal skills and the demonstrated ability to establish rapport and working relationships with peers, executives, direct reports and staff, network providers, service vendors, regulatory and community groups.
- Able to lead, develop and manage a physician team
We are an equal opportunity/affirmative action employer.
Do you have a question about careers at Martin’s Point Health Care? Contact us at:
jobinquiries@martinspoint.org
