Medical Director, Care Management Services
Los Angeles, CA
- Develop, manage and implement newly formed care management and coordination services program for our members.
- The Medical Director will be responsible for the operational component of the care management division which includes program design, strategic planning, regulatory reporting, staffing and staff training.
- This position will work in concert with other divisions within Health Services as well as across its contracted medical provider groups and delivery systems (i.e. Hospitals, providers etc…).
- Assures departmental compliance.
- Achieve NCQA Accreditation.
- Management Services Agreements & Other Contracts.
- Develops and implements departmental policies and procedures, desk procedures and workflows.
- Ensure integration of quality for the Model of Care program and related reporting and monitoring.
- Develops and maintains departmental statistical and performance reports.
- Develops, implements and monitors performance standards.
- Develops and maintains effective communication mechanisms at various levels of the organization and with external organizations.
- Assures appropriate staff support of Care Management committees and work groups and CBOs.
- Strengths collaboration and partnerships to ensure the maintenance of positive relationships providers and community organizations.
- Internal Health Plan Operational Management.
- Assure departmental compliance with applicable management services agreements.
- Performs ongoing monitoring and evaluation of departmental operations to assure optimal efficiency and effectiveness.
- M.D. (Medical Doctor)
- 10+ years relevant Health Care experience with at least 5 years relevant Health Plan experience and management/supervisory experience in a related capacity.
- Experience in implementing and managing of Medicaid and Medicare program requirements.
- Experience in obtaining and sustaining NCQA accreditation.
- Board certified, preferably in primary care. Current and unrestricted Physician license to practice in CA.
- Certified/Qualified to provide Clinical Supervision hours.