Regional Medical Director
Woodland Hills, CA
- Build creditable and trusting relationships with stakeholders regarding performance metrics.
- Serve as liaison for the health plan to ensure that all the opportunities are highlighted through detailed reporting to the leadership at the groups.
- Individually own and lead HBR initiatives that ties to cost savings to the AOP for department.
- Serve as the clinical lead with large employer groups in the bid process.
- Manage assigned departments or functions with an emphasis on execution, outcomes, continual improvement and performance enhancement.
- Maintain relationships with key employer groups, physician groups, individual physicians, managed care organizations, and state medical associations and societies.
- Participate in quality improvement programs to assure that members receive timely, appropriate, and accessible health care.
- Provide ongoing compliance with standardized systems, policies, programs, procedures, and workflows.
- Analyze member and population data to guide and manage program direction such as ensuring that members enroll in clinical programs indicated by their clinical need and monitor performance.
- Participate in the administration of medical management programs to assure that network providers deliver and Plan members receive appropriate, high quality, cost effective care.
- Assure compliance with all regulatory, accreditation, and internal requirements and audits.
- Articulate plan policies and procedures to providers and organizations and works to ensure effective implementation of policies and programs.
- May serve as a member on quality and/or care management programs and committees as directed.
- Graduate of an accredited medical school, plus board certification by the ABMS in a primary care specialty.
- MBA, MPH, or epidemiologist degree preferred. 5+ years of managed care experience; experienced with commercial, Medicare and Medicaid lines of business, experience leading teams and projects which include physicians, case/care managers. utilization review and quality of care.
- Minimum of 3+ years of supervisory/management experience.
- Current state’ s MD license and specialty board certifications.