Associate Medical Director (ME), part-time Job in Portland, Maine US
Who we are
Harvard Pilgrim is a not-for-profit health plan and a full-service benefits company serving members in Massachusetts, New Hampshire, Maine and beyond. We make health care work better. We recognize diversity's impact and importance for our workforce, customers and providers, and through our contributions to the communities we serve. It's part of the way we do business.
What we value
Harvard Pilgrim believes that greatness is built from the inside out. It's created by individuals who share common goals, and who support and rely on one another to achieve them. Our core values guide us in how we treat, respond to and interact with our customers, business partners and one another.
Who we hire
We hire the best and brightest-talented individuals who value innovation, creativity and communication in the workplace. Harvard Pilgrim believes that by attracting, retaining and engaging diversetalent, we gain a sustained competitive advantage for continued growth.
Our employees bring Harvard Pilgrim's mission, values and brand to life in an inclusive and supportive environment where they are respected and valued for their contributions. Being part of the Harvard Pilgrim team means that you excel at what you do. You're dedicated to your work and continually look for new ways to serve your customers better.
What we offer
We do our best to support our employees in making the most of their lives both inside and outside of work. At Harvard Pilgrim, we know that a talented, engaged and inclusive workforce is our greatest strength. We have an excellent benefit package and are "T" accessible.Some of our benefits include:
* A comprehensive work and life benefits program, including medical and dental benefits, time away from work, retirement, financial protection and on-site fitness centers.
* Opportunities to learn and grow, build relationships, share your opinions and do what you do best every day.
* Ways to serve and give back to the communities where you live, work and play - through grants, fundraising and volunteering.
JOB SUMMARY:
The Associate Medical Director is responsible for the development and implementation of the overall provider engagement strategy in Maine for HPHC, and for supporting the organization on all aspects of medical performance (cost and quality) related to clinical services obtained by and offered to Harvard Pilgrim members. This individual is the clinical leader for the development and assessment of pay for performance and incentive programs for the Maine network and will collaborate with other areas such as clinical policy, utilization management, and pharmacy programs. This individual is also accountable for supporting customer/employer needs in the Maine market from a sales, support, and account management perspective. In addition, the Associate Medical Director will provide input to key departments throughout HPHC as they relate to the Maine market including, but not limited to Contracting, Credentialing, Clinical Programs, Provider Payment Policy, and Information Technology.This part-time position is a 0.4 FTE (16 hours/2 days/week).
Essential Functions:
- Participate in strategic planning and implementation of the provider strategy and network agenda.
- Maintain and grow HPHC's influence and leadership in the areas of network management and clinical quality
- Accountable for managing medical cost in Maine market, and developing initiatives to improve cost and quality of care.
- Influence the design and coordination of measurement activities associated with clinical initiatives, network performance, and CMS Quality Assessment
- Engage with clinical leadership and key provider groups, including sharing performance data
- Support provider tiering initiatives
- Accountable for supporting customer/employer needs in the ME market from a sales, support, and account management perspective.
- Develop provider-facing initiatives, oversee implementation and assess impact, including measurement of financial and nonfinancial impact.
- Oversee development, management and evolution of network pay for performance and Quality Grant Programs.
- Manipulate and analyze data as it pertains to provider practice patterns, utilization trend management and cost/quality performance improvement.
- Support broader department efforts related to medical and pharmacy utilization and cost trend.
- Serve on key committees with decision-making responsibilities in areas such as Payment Policy, Medical Trend, and Provider Medical Cost.
- Support disease management and population health initiatives throughout HPHC's network and membership.
- Support Senior Medical Director, local market, government relations staff and others on matters of "public" clinical policy.
- Represents HPHC as needed in external forums
Required Skills
- Graduation from an accredited school of medicine. MBA or other advanced degree desirable.
- Licensed to practice medicine in Maine without restriction. Board certification required.
- 5 years clinical experience; 3-5 years medical management in a health plan or provider organization.
- Excellent communication, analytics, leadership and management skills.