- Engages and provides clinical leadership in quality improvement strategy and tactics
- Chairs the enterprise-wide credentialing committee which is composed of diverse practicing network providers across Minnesota and Wisconsin
- Provides support to care management programs by participating in care management rounds and completing case reviews needing physician input
- Develops effective working relationships with physician peers, health services and pharmacy leaders as well as other Medica leaders for quality, care management and medical expense initiatives
- Completes quality of care reviews for cases requiring physician judgment regarding care that was rendered by network practitioners or facilities
- Medical Doctorate (MD) or Doctor of Osteopathic Medicine (DO)
- 5+ years as clinical provider
- 2+ years of health plan or health system quality improvement experience strongly desired
- Must be a licensed physician with current Board certification of ABMS recognized specialty. Current medical license to practice must be without restrictions. Must be willing and able to successfully apply for medical license in other states as needed.
- Preferred candidates will have experience with leading quality improvement efforts in health plans or clinical organizations, and/or serving as a clinical medical director, and/or prior experience working in a health plan or using health claims data to improve quality
- Outstanding written and verbal and communications skills
- Strong collaboration skills
- Ability to represent the Clinical Services team on various Medica Committees
- Ability to interpret and understand health claims data
- Strong ability to learn and utilize various application technology systems used by health plans (i.e. Microsoft Office Suite, Power BI, Qliksense)
- Excellent leadership skills
- Customer service orientation
- Actively influences and drives discussions toward resolution - shows good judgment and decisiveness
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l Director - Minnetonka, United States - Medica
Description
Medica's Medical Director of Quality and Care Management supports the Clinical Services team via quality improvement activities including but not limited to collaborating with quality teams to improve the care received by our members as judged by HEDIS performance, state Medicaid programs, and other established quality measurement standards.
In support of the Senior Medical Director for Quality, Care Management and Public Policy, this enterprise-wide role requires the ability to actively represent clinical perspectives and provide thought leadership in driving new initiatives to engage providers and members to measurably improve quality performance. The Medical Director for Quality and Care Management will also provide clinical leadership for provider and organization credentialing as Chair of the Medica Credentialing Committee, requiring the ability to lead a diverse group of physician committee members towards consensus decisions.
Key Accountabilities:
This role requires forming productive relationships in leadership dyads with both clinical and non-clinical counterparts, and the ability to respectfully interact with internal and external stakeholders at all levels.
Qualifications:
Preferred Experience:
Skills and Abilities:
This position is a Remote role. The employee must be located in any state in which Medica is an employer and will work remotely 100% of the time.
The full salary range for this position is $196,000 - $336,000. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.
The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.
Medica's commitment to diversity, equity and inclusion (DEI) includes unifying our workforce through learning and development, recruitment and retention. We consistently communicate the importance of DEI, celebrate achievements, and seek out community partnerships and diverse suppliers that are representative of everyone in our community. We are developing sustainable programs and investing time, talent and resources to ensure that we are living our values. We are an Equal Opportunity/Affirmative Action employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR c)
Equal Opportunity Employer including Veterans and Disabled Individuals
