The Medical Director of Care Management Services will develop, manage and implement the plan's newly formed care management and coordination services program for our members. As one of the largest health plan (public and commercial) in L.A. County with 2.1 million members, the plan has a significant amount of resources that can impact those with social and health challenges. Within the Health Services Department, there are the following units and components that can be utilized to better support care management and coordination of services: Medical Management (traditional utilization management services), Behavioral Health Services, Social Services, Disease Management, and Long Term Care Services and Support, Safety Net Initiatives etc…
The Medical Director will be responsible for the operational component of the care management division which includes program design, strategic planning, regulatory reporting, staffing and staff training. This position will work in concert with other divisions within Health Services as well as across the plan, its contracted medical provider groups and delivery systems (i.e.. Hospitals, providers etc…). The position will also represent the plan and interact with the County Health Agency’s Departments of Health Services, Mental Health (DMH), Public Health/Substance Abuse Prevention & Control (SAPC), contracted organizations and providers, medical groups, and other stakeholders in a manner that promotes collaborative working relationships in improving the care management and coordination for our members.
General essential functions include responsibility for oversight functions as well as internal health plan operations associated with the Care Management and Disease Management Programs including planning, directing, implementing and supervisor evaluation for Care and Disease management activities.
Assures departmental compliance with:
Applicable state and federal regulator requirements
Achieve NCQA Accreditation; Management Services Agreements & Other Contracts
Develops and implements departmental policies and procedures, desk procedures and workflows
Ensure integration of quality for the Model of Care program and related reporting and monitoring
Develops and maintains departmental statistical and performance reports
Develops, implements and monitors performance standards
Develops and maintains effective communication mechanisms at various levels of the organization and with external organizations
Assures appropriate staff support of Care Management committees and workgroups and CBOs
Strengths collaboration and partnerships to ensure the maintenance of positive relationships of the plan, PPGs, providers and community organizations.
Internal Health Plan Operational Management:
Assure departmental compliance with applicable management services agreements
Performs ongoing monitoring and evaluation of departmental operations to assure optimal efficiency and effectiveness
Medical Doctor, board certified preferable in a primary care specialty (Internal Medicine, Family Practice, Pediatrics or Emergency Medicine).
10+ years relevant Health Care experience
5+ years relevant Health Plan experience and management/supervisory experience in a related capacity
Experience in implementing and managing of Medicaid and Medicare program requirements
Experience in obtaining and sustaining NCQA accreditation.
Certified/Qualified to provide Clinical Supervision hours.
Current and unrestricted Physician license to practice in CA.