Medical Director - Sharp Health PlanJob ID 85776 Date posted 01/29/2018
- Facility: Sharp HealthPlan
- City: San Diego
- Department: Health Services
- Category: Executive Jobs
- Job Status: Full-Time
- Shift: Day Job
- FTE: 1.0
- Shift Start: Variable
- Shift End Time: Variable
Medical Director – Sharp Health Plan (SHP)
Sharp Health Plan is the largest locally based commercial health plan in San Diego. We are a not-for-profit health plan that has been serving San Diego and southern Riverside Counties since 1992. As a subsidiary of Sharp HealthCare, we are backed by the largest provider of comprehensive health care services in San Diego.
Sharp Health Plan offers a variety of coverage options that combine affordability and choice, while delivering high quality health care and personal service. We provide health insurance for companies of all sizes throughout the region. Members have access to valuable plan enhancements, such as interactive wellness resources, dental discounts and our exclusive global emergency services program.
Working with the Chief Medical Officer, oversees medical care for Sharp Health Plan (SHP) products and services and oversees the health care needs of the membership. Serves as a medical manager and policy advisor to SHP and its Chief Medical Officer. Is accountable for and provides professional leadership and direction to the utilization/cost management and clinical quality management functions. Works collaboratively with other plan functions that interface with medical management such as provider relations, member services, benefits and claims management, etc. Assists (as determined by the plan Chief Medical Officer) in short and long-range program planning, total quality management (quality improvement), and external relationships.
Works with all departments of Health Services to support, provide assistance and direction in overall medical management effectiveness. Reports all issues of clinical quality management to the health plan Chief Medical Officer. To ensure that policies and systems are followed until agreed upon change is implemented. Works toward SHP strategic goals and objectives of ensuring a high quality of medical care for Plan members, staff empowerment, customer satisfaction, cost-effectiveness, and market competitiveness. As a member of the management team, assists in identifying and establishing strategic goals and objectives for the Plan.
Required Skills and Qualifications:
- Minimum of five (5) years of experience in the clinical practice of medicine.
- Previous experience as a physician executive in a managed care environment.
- Minimum two (2) years of experience as a Medical Director required.
- Experience as an HMO Medical Director preferred.
- Strong clinical background and skills.
- Solid understanding of utilization management and quality assurance activities and concepts.
- Knowledge of DMHC, NCQA, CMS, HEDIS, UM, Appeals and grievances preferred.
- Knowledge of regulatory and accreditation agencies and requirements.
- Able to manage multiple priorities and deadlines in an expedient and decisive manner.
- Able to manage difficult peer situations arising from medical care review.
- Appreciation of cultural diversity and sensitivity towards target population.
- Excellent communication skills, both verbal and written.
- Strong interpersonal skills, including the ability to interface effectively with employees, members, physicians, senior management, and the public at large.
- Management skills to meet the organizational goals
- Doctor of Medicine degree (i.e. M.D. or D.O).
- Board certified in a medical discipline (internal medicine or family practice preferred).
Current unrestricted California medical licensure.
- Responsible and accountable to the Chief Medical Officer for helping to manage health plan medical costs and assuring appropriate health care delivery for SHP's products and services. Reports organizationally to the Chief Medical Officer.
- Plans, organizes, and directs the professional medical services program, consisting of all primary and specialty services for in-patient, out-patient, preventive and wellness programs.
- Implements health plan medical policies, goals and objectives.
- Provides professional leadership and direction to the functions within the Medical Management Department (Utilization/Cost Management and Quality Management)
- Department (Utilization/Cost Management and Quality Management.
- Responsible for and assists with the development of staffing plans and assuring the adequate allocation of resources to the medical management functions.
- Responsible and accountable for implementing the Utilization/Cost Management Program and Quality Improvement Program, in conjunction with the Manager Medical Management and Director Quality Improvement .
- Assists the Chief Medical Officer with activities to promote positive community relations.
- Assures plan conformance with legal and regulatory requirements.
- Assists the Chief Medical Officer and the Director Quality Improvement in creating and maintaining a system that gives feedback to providers individually and collectively regarding managed care effectiveness of individual providers and networks.
- Assists the Chief Medical Officer in designing and implementing corrective action plans to address issues and improve plan and network managed care performance.Compensation and Benefits:The position provides a very competitive compensation, including opportunity to participate in an entity incentive program along with a generous benefit package.Physical Requirements may be discussed during the interview“Sharp HealthCare is proud to be an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, gender identity, transgender status, sexual orientation, protected veteran status or any other protected class.”Keywords: Medical Director, MD, DO, Board Certified Internist, Sharp Health Plan jobs, Health Plan, Managed care, Covered California, HMO, PCP jobs, Medical Director jobs, Managed Care Medical Director jobs