Medical Director (MD or DO) - Managed Care
Your Job Summary:
The Medical Director is a key contributor to the team promoting an Emergency Department triage/tele-health software to reduce over-utilization of hospital ERs. The Medical Director reports directly to the Director of Commercial Operations and Product and works closely with the President of the platform program, client stakeholders and network delivery partners. The Medical Director takes a clinically data-driven and fact-based approach in establishing medical control policies and protocols and in evaluating the quality and performance of the network of medical control resources. The Medical Director should be comfortable operating in a fast-paced environment, as part of a scrappy but committed team of individuals focused on responsibly reducing health care costs, improving clinical quality and increasing patient and provider satisfaction for all clients.
- Formal education including a Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) degree.
- Prefer, but does not require, an active unrestricted license to practice medicine in the state at hire.
- Prefer candidates be Board Certified (or eligible) in Internal Medicine or Family Medicine.
- At least 5 years clinical experience practicing medicine, with at least 2 years in an administrative capacity.
- Prefer around 2-3 years’ experience working for a Healthcare Software company, and/or a Payer Organization (Health Plan/IPA/HMO/TPA/etc).
- Substantial knowledge of quality improvement, monitoring and evaluation, health systems strengthening, innovation and training is desired, although not essential
- Excellent written and verbal communication skills; and strong critical thinking, deductive reasoning and decision making skills are needed.
- Ability to implement complex programs and to monitor implementation and modifications.
- Develops and monitors medical control scope and capacity.
- Develops network of MD/DO to serve as on-call Medical Control for network partners and participates in Medical Control coverage.
- Coordinate MD/DO coverage schedule and create effective back up system.
- Creates onboarding and ongoing education programs for new MD/DO.
- Identifies and trains MD/DO trainers who will support ongoing training and QA/QI initiatives.
- Monitors performance of MD/DO Medical Control including case audits, remediation interventions, and yearly performance plans.
- Develops and participates in Morbidity and Mortality rounds with clients and network delivery partners.
- Reports on overall performance of Medical Control program to CMO.
- Partners with Director of Commercial Operations and Product to source qualified network partners.
- Contributes to all ongoing development and refinement of educational materials for network delivery partners.
- Develops new, evidence based care protocols for community paramedic visits as indicated, concerning triage, physical exam, lab/testing, immediate treatment, and communication expectations, in collaboration with clinical operations team.
- Reviews, coordinates, and participates in all training for network delivery partners.
- Reviews and updates all of the above on an annual basis or more frequently if indicated.
- Audits service delivery and addresses any deviance from above protocols.
- Participates in qualified business development discussions.
- Collaborates with Client Success team during network and client implementation efforts.
- Serves as medical in client operating reporting schedule.
- Participates in monthly executive operating reviews.
- Maintains required professional credentialing and appropriate CME standards.