Regional Medical Director

Woodland Hills, CA

Posted: 12/14/2018 Category: Registered Nurse Job Number: 23376
Job Description:
  • 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.
Education/Experience:
  • 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.
License/Certification:
  • Current state’ s MD license and specialty board certifications.
For more information on this position, please contact our office at 877-782-3334.
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