Job Information
Healthfirst AVP - Medical Director for Complex Care in Hybrid, New York
Duties and Responsibilities:
Provide day-to-day oversight and leadership of the Complex/Catastrophic Care Interdisciplinary team
Provide clinical leadership of the multi-disciplinary rounding process, as well as care management rounds and peer-to-peer discussions with health systems, vendors and other internal and external collaborators.
Participate in the development and implementation of new or updated formal policy and procedures for UM, CM, Credentialing, Delegation and QA/QI
Collaborate with other business leaders in the design of workflows and job aides developed to implement designated policies (see above). This includes participating in the design and execution of training plans for clinical staff, lay staff, and peer review professionals.
Serve as a voting member (as assigned) on Credentialing, QI/QA, UM, CM, A&G and Delegation Committees/Subcommittees acting as an expert clinical leader. Collaborate with business owners to implement any new policies or directives from these committees.
When needed, manage peer review and clinical case review activities for UM, CM and A&G using approved policies and procedures within designated workflows to provide specific clinical insight and decision making on specific cases. This includes maintaining all regulatory requirements for timely and complete decision making.
Interact and interface (via face-to-face, telephone or email) with physicians, hospitals and other health care providers as required to support the policies and procedures of HF.
Collaborate with business leaders in internal and external audit activities including preparation and participation. This includes the management of audit activities for peer review professionals.
Additional duties as needed
Minimum Qualifications:
Graduate of MD/DO program with valid license
Experience overseeing or working directly with plan-based care management teams
Preferred Qualifications:
Board Certified in Internal Medicine or Family Practice
Analysis of Quality and Utilization Data for use in clinical programs
Experience with public speaking, public communication, and training others
Experience usingCM/UM software and electronic medical records
Clinical experience with direct care of patients in ambulatory and inpatient setting
Experience with administrative aspects of health care in a hospital, a managed care plan or a large multispecialty clinic such as developing policy and then implementing and supporting procedures forcredentialing, QI/QA, UM, CM, Delegation and A&G.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.