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Regional Medical Director, Jacksonville/Daytona, Florida

Company: Conviva
Location: Jacksonville
Posted on: May 23, 2020

Job Description:

Medical Director opening in Jacksonville, Florida. This and other physician jobs brought to you by DocCafe.com Role DescriptionThe Regional Medical Director will work collaboratively in Conviva regional markets and with market physician leadership and operations for the purpose of Utilization Management and Care Facilitation. The Regional Medical Director will perform clinical medical necessity reviews and complete peer to peers as assigned for Utilization Managements purposes. In addition, the Regional Medical Director will work with the Care Facilitation Nursing organization to transition and follow patients from clinics through all levels of care in facilities, and back into the clinics. The Regional Medical Director must understand the role of family medicine as provided in the Conviva clinics by PCP providers. In some circumstances, the Regional Medical Director may possibly oversee the work of other Medical Directors who conduct clinical case reviews as well as facilitate care through transition levels of care. In this case, the Regional Medical Director is accountable for orientation, training, coaching and mentoring the Medical Director.The Regional Medical Director is responsible to serve as a physician advisor to the local market physician leadership, market clinical operations, utilization management and care facilitation nursing department who are responsible for clinical process. They are accountable for participating in the market goals, strategies and tactics for improvement as well as monitoring market clinical metrics and giving guidance to both the UM Clinical and Care Facilitation Teams.Role Competencies· Holds self accountable with the ability to work with other physicians and team members to support and hold each other accountable in a professional manner· Have understanding, experience and ability to work with senior care medical clinics· Excellent written and verbal communication skills. Demonstrate active listening skills; communicate clearly and concisely; ensure understanding regardless of the communication vehicle; understand the needs and perspectives of others with ability to tailor the delivery accordingly; share information appropriately · Emotional Maturity as demonstrated by an understanding of oneself to manage emotions; listen to and understand others; able to build trusting relationships with patients, providers, and care team; understand proper use of chain of command and know when and how to escalate. · Ability to work independently under general instruction but also understands how to collaborate with a team of all levels· Attention to detail with ability to work in a fast paced environment to meet regulatory time frames· Responsible for achieving organization goals and metrics; accountable for results of assignment; take accountability for results· Strong organization and time management skills with the ability to prioritize; organize and manage multiple priorities and/or projects using appropriate methodologies and tools· Demonstrated ability to create a positive and meaningful patient, provider and care team experience· Flexible to changes in assignments and teams· Proactively identify, evaluate, and solve problems with logic and a systematic approach; look beyond the obvious to see root cause issues and creative solutions. Make appropriate decision in the face of ambiguity. Anticipate and resolve barriers and constraints Provider physician review services for utilization management and care facilitation· Develop, maintain and assure compliance with physician review policies and procedures (including timeliness) for utilization management and support case management.· Act as the physician advisor to ensure patients are moving through all levels of the transition of care· Support collaborative relationships with market PCPs, Area Medical Leads, Center Medical Director, specialist physicians, large provider groups, hospitals, ancillary providers and other facilities in the market.· Help control local utilization of services.· Work closely with market medical directors to ensure members are at the right level of care and facilities are moving patients to the next appropriate level of care.· Identify potentially unnecessary services in care delivery settings and recommend alternatives if appropriate by analyzing clinical protocols. · Examine clinical program information to identify members for specific case management and/or disease management activities or interventions by utilizing established screening criteria. · Advise nursing on clinical programs, strategy and intervention to improve level of service for utilization management and care facilitation.· Conduct medical necessity reviews for acute and post-acute initial admission reviews, DME, Home Health continued stay, Skilled Nursing continued stay reviews and support and initiate authorizations and notifications for Home Health· Lead care facilitation "Daily" Clinical Rounds Discussion as well as "Weekly" Concurrent Rounds, direct and educate nursing staff on specific conditions and disease processes· Support the roll out of clinical initiatives in the local markets through work with the local market physician teams and care coaches Preferred Education, Experience & Skills· MD or DO degree · Board Certified in an approved ABMS Medical Specialty · Five years clinical patient facing experience – post residency· Excellent communication skills · Technical ability with Microsoft Applications and other computer based programs· Experience working with and/or directing clinical nursing personnel· Health Plan experience · Previous Medicare Advantage/Medicare/Medicaid experience · Previous experience leading teams focusing on utilization management, discharge planning and/or home health or rehab · Process-oriented, evidence-based and scientifically-inclined, consistent, enjoys being a part of a team, thoughtful and has a thirst for continuous education and development· Additional Education: BSN or Bachelor's degree in a related field · Previous experience in Front End Review, SNF, LTAC, DME or Home Health· English and Spanish bilingual preferred Compensation

  • $250,000 Base Salary
  • Metric Driven Bonus (paid twice per year)
  • Paid CME
  • Full Benefits including 401K match and Paid family healthcare
  • Local Travel Required, Limited Overnight Stays Keyphrases: health administration jobs, medical director jobs, hospital administration jobs, hospital administrative jobs, healthcare administration jobs, administration jobs, healthcare administrator jobs, medical administration jobs, chief medical officer jobs, medical director position jobs, associate medical director jobs, medical administrative jobs, healthcare ceo jobs, medical ceo jobs, executive director jobs

Keywords: Conviva, Jacksonville , Regional Medical Director, Jacksonville/Daytona, Florida, Healthcare , Jacksonville, Florida

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