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Medical Director

Company: Kern Health Systems
Location: Bakersfield
Posted on: November 8, 2019

Job Description:

Medical Director, Internal Medicine, Family Practice, Clinical, Hospital, HMO, Managed HealthCare, Acute care, General Practice, Utilization Review, Remote, Prior Authorizations, Inpatient Reviews

Remote or On-Site

**Relocation Assistance Available**

Kern Family Healthcare. The friendly face

We are looking for fun, intelligent, team oriented people who believe in our core values: Trust, Respect and Integrity.

Position Summary

TheMedical Director will provide clinical leadership and guidance in the development and measurement of the strategic approach to quality, performance improvement, and patient satisfaction, and safety. As determined by the plan Chief Medical Officer, the Medical Director assists in short and long range program planning, total quality management (quality improvement) and external relationships, as well as, develops and implements systems and procedures for all medical components of health plan operations.Medical Director, Internal Medicine, Family Practice, Clinical, Hospital, HMO, Managed HealthCare, Acute care, General Practice, Utilization Review, Remote, Prior Authorizations, Inpatient ReviewsIn collaboration with the Chief Medical Officer and others, the Medical Director creates and implements health plan medical policies and protocols. The Medical Director monitors provider network performance and reports all issues of clinical quality management to the Chief Medical Officer and Quality Improvement Committee. Additionally, he or she represents the health plan on various committees and routinely reports to the Board of Directors on credentialing and re-credentialing of network providers. The Medical Director provides medical oversight into the medical appropriateness and necessity of healthcare services provided to Plan members and is responsible for meeting medical cost and utilization performance targets.

Medical Director, Internal Medicine, Family Practice, Clinical, Hospital, HMO, Managed HealthCare, Acute care, General Practice, Utilization Review, Remote, Prior Authorizations, Inpatient Reviews

Essential Duties and Responsibilities

Under direction of the Chief Medical Officer:



  • Serves as a member of the following committees of the KHS Board of Director: Physician Advisory Committee; Pharmacy and Therapeutics Committee; Quality Improvement Committee and Utilization Management Committee (Serve as Chairperson of the committees as delegated by CMO.) Attend committee meetings as scheduled;




    • Participates in carrying out the organizations mission, goals, objectives and continuous quality improvement of KHS



    • Is responsible for monitoring and controlling the appropriate utilization of health care services in order to achieve high quality outcomes in the most cost effective manner;



    • Provides physician leadership to KHS staff and health care providers;



    • Responsible for the clinical aspects of member and provider appeal processing and decision making;



    • Contracts and coordinate the services of peer-review organizations and individual physicians to satisfy matched-specialty reviews for utilization management and appeals decisions;



    • Collaborates with leadership team on the effective medical cost and utilization performance of the health plan and assist with the development and deployment of strategies for effective medical cost and quality of care management;



    • Supports the selection, development and maintenance of the care management information system that supports utilization management, case management and chronic care management operations;




      • Participates in the implementation of the KHS Credentialing Program;



      • Responsible for implementation and refinement of KHS Quality Improvement Plan and the Utilization Management Plan;



      • Direct and facilitate educational campaigns and performance improvement projects directed toward improving patient care and reducing unnecessary resource utilization;



      • Lead and/or attend and actively participate in meetings and committees as assigned by the CMO



      • Obtains support of the medical community for QI, UM, DM and CM programs



      • Participates as an effective member of the management team



      • Performs duties and responsibilities identified for the Medical Director under the Quality Improvement Plan, the Utilization Management Plan, and such other programs/plans that the Board may adopt or as mandated by the Department of Health Care Services or CMS;



      • Directly communicates with primary care physicians and other referring physicians in order to resolve referral issues, research treatment protocols, solicit advice on problem cases, and to assist in development of referral criteria and practice guidelines;



      • Supports, communicates, and collaborates with KHS case managers in order to resolve case management and referral issues;



      • Strong knowledge of common patient disease processes and usual methods of treating;



      • Knowledge of medical terminology and commonly used equipment; Knowledge of ICD9 and/or CPT coding;



      • Demonstrated thorough knowledge of health care delivery systems and HMO regulatory requirements, including DMHC and CMS compliance;



      • Ability to read, interpret and apply written regulations, guidelines and other materials;



      • Strong analytical, assessment and problem solving skills with intermediate negotiation skills;



      • Very strong interpersonal skills, including the ability to establish and maintain effective working relationships with individual at all levels both inside and outside of KHS;



      • Ability to use tact and diplomacy to diffuse emotional situations;


        Medical Director, Internal Medicine, Family Practice, Clinical, Hospital, HMO, Managed HealthCare, Acute care, General Practice, Utilization Review, Remote, Prior Authorizations, Inpatient Reviews

        Employee Standards

        -- Licensed M.D. or D.O. in good standing in the state of California

        -- Board eligible or certification in their area of specialty by the American Board of Medical Specialists (ABMS)

        -- MPH, MBA, or MHA Preferred

        -- Certification by the American Board of Quality Assurance and Utilization Review Physicians or the American Board of Medical Management preferred

        -- Minimum of 3 years medical leadership experience in a managed care organization or clinical setting

        -- Minimum of 5 years of clinical practice experience

        -- History of successful clinical outcomes and ability to analyze data for quality improvement and outcomes

        -- Have an understanding of quality improvement cycle processes and outcome analysis

        -- Expertise in healthcare delivery systems and quality performance improvement initiatives

        -- Basic competency in email, word processing, Excel and internet programs

        -- Good manual and finger dexterity is needed; up to 75 percent of working time may be spent using a computer keyboard

        -- Vision, hearing, speaking: must have good visual acuity and depth perception to operate the computer system; speaking and hearing are essential to the communication needs of the position

        -- May be requested on occasion to travel to conferences and meetings as an organization representative. Must be able to make arrangements to attend these as required

        Medical Director, Internal Medicine, Family Practice, Clinical, Hospital, HMO, Managed HealthCare, Acute care, General Practice, Utilization Review, Remote, Prior Authorizations, Inpatient Reviews

Keywords: Kern Health Systems, Bakersfield , Medical Director, Executive , Bakersfield, California

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