Medical Director
James L. Dooley & Associates, Inc. (Atlanta, Georgia)

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Medical Director

Atlanta, GA

 

The Market Medical Director has:

Accountability for ensuring that Clinical Operations initiatives focusing on affordability Clinical excellence, growth and focused improvement are implemented.Responsible for leadership and execution of all market medical expense management and clinical quality activities.  Collaborates with the market CEO, clinical operations staff, and other market staff to implement programs to support and meet market and national clinical operations goals, as well as market, network and sales objectives. Direct management and oversight of local market Clinical Operations staff.   Reports to National Field Medical Director with accountability to the local market CEO and Medical Directors of Hospital/Physician Utilization Management and Clinical Excellence.

Major Responsibilities:

Clinical Excellence – Oversee the HEDIS data collection process and drive Health Plan accreditation activities.  Act as liaison for potential vendor changes; gather market data; act as an improvement catalyst.  Communicate to providers on new focus and measure/process changes.  Support all Clinical Quality initiatives and peer review processes including QOC and QOS issues.  Examples of metrics would include measures such as TAT for QOC/QOS resolution; % of increase in HEDIS scores by market; and quality audit results.Growth – Deliver the clinical value proposition in support of the sales and growth activities of the Health Plan including conducting Broker/Client presentations and participating in customer consultations.  Review and edit communications materials as required.  Represent the voice of the customer in program design.  Promote positive relations with State/local regulatory authorities and Medical Societies. Examples of metrics would include measures such as the number of Clinical Solutions visits per month and metrics demonstrating the impact of those visits to include customer retention, new sales, and up-sell activities.Focused Improvement – Responsible for identifying opportunities through participation in local Medical Expense Committees. Active participation in support of Joint Operating Committees.  Provides local feedback on and oversight of the performance of Care Coordination, Behavioral Health as requested by the National Director, Clinical Quality Outcomes, the Patient Safety, and the National Director, Medical Expense Management. Examples of metrics would include TAT for the adoption and implementation of Clinical Operations initiatives; the number of programs under adoption in the local market; and the percentage reduction of medical costs by Health Plan.

Qualifications:  

Licensed Physician; Board Certified in ABMS specialty5+ years clinical practice experience; strong knowledge of managed care industry.2 – 3 years Quality management experienceFamiliarity with current medical issues and practicesExcellent interpersonal communication skillsSuperior presentation skills for both clinical and non-clinical audiencesProven ability to develop relationships with network and community physicians and other providersExcellent project management skillsSolid data analysis and interpretation skills; ability to focus on key metricsStrong team player and team building skillsStrategic thinking with proven ability to communicate a vision and drive resultsSolid negotiation and conflict management skills  Creative problem solving skills.Basic proficiency with Microsoft Office applications

Competencies and Best Practice for High Performers:

Support the Employee Value Proposition (EVP) - Demonstrate and lead support for client’s values: Performance Driven, High-Velocity Change, Operating Efficiency, Top-Performing Employees Are Our Greatest Asset, Cutting Edge, Build Value to Customers, Accountability Through Matrix Management.

 

Ability to build a team that values organizational success over personal success; provide ongoing coaching and feedback to ensure peak performance; identify and invest in high-potentials; actively manage underperformance.Focus staff on the company's mission; inspire superior performance; ensure understanding of strategic context; set clear performance goals; focus energy on serving the customer; provide ongoing communication to the team; discontinue non-critical efforts.Execute with discipline and urgency: Drive exceptional performance; deliver value to the customer; closely monitor execution; drive operational excellence; get directly involved when needed; actively manage financial performance; balance speed with analysis; ensure accountability for results.  Drive change and innovation though continually seeking and implementing innovative solutions; create a culture that thrives on continuous change; inspire people to stretch beyond their comfort zone; take well-reasoned risk; challenge "the way it has always been done"; change direction as requiredAbility to develop relationships with network and community physicians and other providers.Visibility and involvement in medical communityAbility to successfully function in a matrix organization.

Qualified and experienced Managed Care Medical Directors reply to:

 

2655 Med Dir JLD GA  jim@theheadhunter.com

 

Jim Dooley, President
James L. Dooley & Associates, Inc.

 

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