Regional Medical Director for Managed Care Organization

Location: Woodland Hills, CA, United States
Position Purpose: Build creditable and trusting relationships with stakeholders regarding performance metrics. Serve as liaison for the health plan to ensure that all the opportunities are highlighted through detailed reporting to the leadership at the groups. Individually own and lead HBR initiatives that ties to cost savings to the AOP for department. Serve as the clinical lead with large employer groups in the bid process. 
  • Manage assigned departments or functions with an emphasis on execution, outcomes, continual improvement and performance enhancement.
  • Maintain relationships with key employer groups, physician groups, individual physicians, managed care organizations, and state medical associations and societies.
  • Participate in quality improvement programs to assure that members receive timely, appropriate, and accessible health care.
  • Provide ongoing compliance with standardized systems, policies, programs, procedures, and workflows.
  • Analyze member and population data to guide and manage program direction such as ensuring that members enroll in clinical programs indicated by their clinical need and monitor performance.
  • Participate in the administration of medical management programs to assure that network providers deliver and Plan members receive appropriate, high quality, cost effective care.
  • Assure compliance with all regulatory, accreditation, and internal requirements and audits.
  • Articulate plan policies and procedures to providers and organizations and works to ensure effective implementation of policies and programs.
  • May serve as a member on quality and/or care management programs and committees as directed.
Qualifications:
Education/Experience:
  • Graduate of an accredited medical school, plus board certification by the ABMS in a primary care specialty.
  • MBA, MPH, or epidemiologist degree preferred.
  • 5+ years of managed care experience; experienced with commercial, Medicare and Medicaid lines of business, experience leading teams and projects which include physicians, case/care managers. utilization review and quality of care.
  • Minimum of 3+ years of supervisory/management experience.
License/Certification: California Medical License and specialty board certifications.
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