Medical Director / 3230 Job in Portland 97062, Oregon US
Position Description
Medical Director / 3230
Position Description:
At APS Healthcare, we are passionate about changing behaviors of all constituents in the healthcare system to improve health, optimize clinical quality, and reduce associated costs. Our mission, quite simply, is to improve the health of those we serve. APS is managing the Oregon Health Plan Care Coordination (OHPCC) Program, which supports high-risk clients with chronic illness through disease management and medical care coordination. The program supports providers and assist clients in becoming and staying healthy by reinforcing treatment plans and by educating patients on making responsible decisions about their healthcare.
As a Medical Director with APS Healthcare in Tualatin, OR you will provide guidance for the clinical operational aspects of programs related to clinical operations including clinical leadership in the areas of utilization management and quality assurance. This key role will serve as a liaison with the medical community and is a member of the corporate medical directors group.
This position is part time 20-30 hours per month.
Essential Functions
1. Participates in the operations leadership team
• Participates in the development of the overall strategy to perform contract deliverables
• Develops performance metrics for clinical and quality improvement (QI) staff
• Ensure a appropriate clinical and QI staff are in place to carry out the functions of the contract
• Develop a resources for nurses and providers
• Organizes, oversees and supervises the Physician Peer Consultation process
2. Conducts provider liaison/education and outreach
• Collaborates with external physician and provider organizations to promote the program
• Provides CME presentations in multiple venues
• Provides ongoing communication to providers including fielding questions, complaints, and issues resolution/problem solving
• Provides ongoing monitoring and feedback, including individual provider consultation
• Participates in advisory committees/chair statewide stakeholders group to develop strategic relationships with providers and provider organizations
• Conducts periodic consultation with practitioners in the field.
3. Conducts oversight of QI activities
• Chairs the clinical advisory panel
• Supervises or closely work in collaboration with the QI Coordinator for the project to develop and implement the Quality Assurance (QA) Plan
• Ensures that local policy and procedures are consistent with evidence based guidelines and contract/APS/URAC standards
• Develops appropriate clinical metrics
• Works with health intelligence staff to design appropriate feedback and reporting mechanisms
• Performs ongoing data review and analysis to determine outcomes and develop QI strategies as a result of findings as appropriate
4. Supports liaison with sponsoring agency
• Addresses ad hoc issues and referrals from contractor
• Participates with ongoing feedback to the contractor on clinical contract performance
• Serves as the organizational representative on community research or quality improvement projects, as agreed to by the contractor
5. Corporate Responsibilities
• Member of the Corporate QI Team, including, participation in committees, strategy and plan development, program evaluation
• Member of the Medical Directors’ Team to work on system-wide projects, including training, standards development, corporate QA Plan, and recommendations for responses to Request for Proposals
• Supports the acquisition of new or expanded business and conduct sales calls, as requested to provide clinical input
• Develops and make presentations at conference and other forums, as requested
• Participates in outcome analysis, journal and newsletter article development
Education
• A Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) degree from an accredited University and a minimum of five years postgraduate clinical experience is required.
• An active, unrestricted license to practice medicine in the state of OR is required. Current board certification in a specialty recognized by the American Board of Medical Specialists or American Osteopathic Association is required.
Qualifications
• Minimum of 5 years postgraduate clinical experience and a solid understanding of disease management and/or utilization management
Ability to write reports, business correspondence, and procedure manuals.
• Ability to effectively present information and respond to questions from groups of staff, managers, clients, customers, and the general public.
• Excellent interpersonal skills are required. Must have knowledge of current health care trends.
• Knowledge of insurance plans and basic plan language would be helpful.
• Ability to effectively present information and respond to questions from groups of managers, clients, customers and the general public.
• Must be able to work with a culturally diverse population.
• Excellent problem solving and negotiation skills.
• Present personal characteristics, professional and ethical behavior conducive to maintaining company’s high standards of staff performance.
• Ability to apply principles of logical or scientific thinking to a wide range of intellectual and practical problems.
• Ability to deal with nonverbal symbolism in its most difficult phases. .
• Ability to apply principles of logical or scientific thinking to a wide range of intellectual and practical problems.
• Ability to deal with a variety of abstract and concrete variables.