Medical Director, Care Management - Oakland, United States - Altais

Description

Job Description

About Our Company

At Altais, we're looking for bold and curious clinicians and innovators who share our passion for enabling better health care experiences and revolutionizing the healthcare system for physicians, advanced care providers, patients, and the clinical community. At Altais, we're building breakthrough clinical support tools, technology, and services to let doctors do what they do best: care for people. We invite you to join our growing passionate team as we change the game for the future of healthcare and enable the experience that people need and deserve. Altais family of companies include Brown & Toland Physicians, Family Care Specialists and Altais Medical Groups.

About Your Team

Are you looking to build your working with a high performing, fast growing and dynamic Clinical team? We are 4,000+ physicians, working in over 40 cities throughout California, caring for more than 500,000 patients. If you are passionate about reshaping healthcare and want to work for a mission driven organization where new ideas and innovation are valued, then we would like to meet you.

About Your Work

The Medical Director of Utilization and Medical Management will report directly to the Senior Medical Director with a dotted line to the Chief Officer for Health and Innovation, and work closely with the Altais Clinical Leadership team in ensuring the delivery of high-quality, efficient and comprehensive healthcare services throughout the continuum of care. This role facilitates and provides information and education for Altais to enable better understanding and skill enhancement in the medical, financial, and utilization practice functions of managed care.

You will focus on:

• The Medical Director plays a vital role in both the development and implementation of Utilization Management policy and procedures. This physician is chosen based upon their knowledge of medical practice, experience in Managed Care, Utilization, Quality Management programs and an ability to interact well with the other physicians.
• Works to continually enhance the overall efficiency and quality of care for patients served by One Altais through effective network management.
• Develop and maintain collaborative functioning relationships with key providers, particularly thought leaders, across the One Altais service delivery footprint.
• The Medical Director will provide cooperative leadership and direction to the UMC (Utilization Management Committee) Primary Care Physicians (PCP) and all Specialist Physicians as assigned by the Senior Medical Director.
• The Medical Director may be asked to co-chair several committees including the Utilization Management Committee, The Quality Management Committee, the Peer Review and Patient Safety Committee, and others as needed.
• The Medical Director may be responsible for interfacing with health plans regarding benefits, coverage issues, response to appeals, attend HMO hearing on appeals and administrative issues which cannot be settled by the Case Managers and/or Management.
• The Medical Director will work closely with physician leaders across all healthcare settings to ensure that patient care is managed in a cost containment manner without compromising health outcomes.
• This physician leader will facilitate clinical rounds with the Case Managers & Management to ensure bed day performance goals are met.
• Collaborate with the Senior Medical Director and Chief Office for Health and Innovation to engage network physicians with regard to performance, cost, clinical appropriateness and authorizations.
• This individual takes an active role in the development and promotion of managed care systems within One Altais. This will include development of UM policies and procedures, identifying the type of criteria to be used for authorization review, and implementation of a regular forum in which to educate PCPs and specialists on utilization management systems.
• The Medical Director also serves as an important resource and key contact for identified case management problems and participates in IDCT (Interdisciplinary Care Team) Meetings.
• The Medical Director supports the Senior Medical Director as a resource person for Physician Education on UM and input into the One Altais UM goals and objectives.
• Coordination of prospective, concurrent, retrospective review including denial and/or approval of all outside medical services referrals as necessary.
• Develop and maintain written medical care protocols and assure UM Standardization.
• Chart Reviews for Appropriateness of applying clinical guidelines.
• Physician to Physician liaison for UM related issues.
• Prepare and review Decision Validation Criteria as required by UM.

Required Meetings:

• UM Committee
• Health Plan Joint Operations Meetings
• Hospital Joint Operations Meeting
• One Altais Meetings involving Utilization Management

The Skills and Experience you bring:

• Strong clinical skills
• Knowledge of utilization management techniques
• Strong interpersonal and communication skills.
• Must have a demonstrated ability to secure the trust and confidence of employees at all levels, in a manner that assures an effective, open and productive working relationship.
• Must be effectively and confidently able to provide advice and expertise as a medical professional, and stay abreast of changes, innovations, and trends in the industry.
• Doctor of Medicine degree; valid California licensure; Current Board certification, preferably in a broad based specialty such as Internal Medicine, Family Practice, Emergency Medicine, Geriatrics, General Surgery or Pediatrics.
• A minimum of seven years as a practicing inpatient and outpatient physician in a managed care environment with10+ years preferred.
• Utlization management and medical management experience.

You Share Our Mission & Values:

• You are passionate about improving the healthcare experience and want to be part of the Altais mission.
• You are bold and curious- willing to take risks, try new things and be creative.
• You take pride in your work and are accountable for the quality of everything you do, holding yourself and others to a high standard.
• You are compassionate and are known as someone who demonstrates emotional intelligence, considers others when making decisions and always tries to do the right thing.
• You co-create, knowing that we can be better as a team than individuals. You work well with others, collaborating and valuing diversity of thought and perspective.
• You build trust with your colleagues and customers by demonstrating that you are someone who values honesty and transparency.

Altais values the contribution each Team Member brings to our organization. Final determination of a successful candidate's starting pay will vary based on several factors, including, but not limited to education and experience within the job or the industry. The pay scale listed for this position is generally for candidates that meet the specified qualifications and requirements listed on this job description. Additional pay may be determined for those candidates that exceed these specified qualifications and requirements. We provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs.

The anticipated pay range for this role is listed in our salary posting for transparency but may vary based on factors including the candidate's qualifications, skills, experience, and geographic location. This base pay range is specific to California and can vary based on Bay Area, Metro LA, and Greater California regions which may not be applicable to other locations.

Altais and its subsidiaries and affiliates are committed to protecting the privacy and security of the personal information you provide to us. Please refer to our 'CPRA Privacy Notice for California Employees and Applicants' to learn how we collect and process your personal information when you apply for a role with us.

Physical Requirements: Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork – Activity level: Sedentary, frequency most of workday.

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.