Medical Director, Care Management Services

Los Angeles, CA

Posted: 10/11/2019 Category: Healthcare Job Number: 33246

Job Summary
  • 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.

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