The Chief Executive (CE) provides overall physician and administrative leadership toPhysician Services Organization (PSO). The CE isresponsible for ensuring the highest quality of medical care delivered by its physicians andsupport staff, achieving cost effectiveness/utilization of services provided, and oversees physician practice issues. The CE oversees clinic operations and programs to ensure operational controls and efficiencies,financial strength, and successful performance improvements standards. In this position you will:
- Lead and participate in the strategic development of PSO in line with PH&SA goals, strategies and objectives.
- Provide vision, leadership, organization skills, developmental skills, and management skills to initiate and operate physician group practices.
- Work closely with Chief Strategy and Administrative Officer in the establishment and operation of support services for the clinics of PSO.
- Serve in a supervisory role over the PSO Medical Directors and Clinic Practice Managers.
- Participate in the development and implementation of physician leadership training.
- Serve as a Region’s principal liaison for employed physicians.
- Collaborate with the senior management team to develop and implement plans for the operational infrastructure of systems and workforce planning to accommodate the predicted growth.
- Identify needed changes in management of care and develops, advocates, and implements policy changes.
- Lead the development and implementation of assessing patient and provider satisfaction.
- Monitor to ensure policy/procedures support efficient and effective patient access to PSO physicians.
- Establish physician productivity standards based on productivity and quality metrics.
- Oversee the financial management of PSO including annual budget and clinic operations to achieve budgeted net revenue.
- Participate in recruitment of physicians and other key management positions.
- Oversee the establishment of physician compensation plans based on productivity and quality metrics.
- Provide support to the credentialing and re-credentialing process, and assists in contracting.
- Serve as a principal liaison for the Region in managed care activities.
- Serve as the principal medical manager of quality and utilization management. Leads and oversee the activities and functions of the Quality Council.
- Provide leadership and oversight to assure advancing and/or improving quality and clinical outcome initiatives and peer review.
- Establish, oversee and lead committees in the areas of quality assurance, utilization review, outcomes management and reimbursement.
- Ensure that corrective medical action plans which result from these committees, or other such bodies, are implemented.
- Assist in formulation of health service utilization and cost forecasts with ongoing responsibility to monitor and execute controls designated to meet budgeted targets.
- Work with CFO to meet critical indicators of the PSO’s success. Accountable for the PSO’s performance in medical management.
- Work with physicians and physician extenders, individually and in groups, to analyze experience and practice patterns. Counsels and trains participating physicians who have questionable patterns of utilizing inpatient or ancillary services, referrals, and/or other medical services.
- Interface with Providence Health Plan and other insurers to assure access and effective programs of medical management.
- Work directly on an individual or group basis with PSO physicians, physician extenders, and/or PSO members to resolve grievances arising from medical care review or medical policy issues. Assists Customer Service in administration of grievance procedures.
- Provide review and advice for utilization management policies, criteria, and protocols.
- Implement medical policy/procedure guidelines, including evaluation of new medical procedures.
- Provide daily support and appropriate direction to staff on issues pertaining to prior authorization, concurrent and retrospective review, quality assurance, risk management and concurrent medical claims review. Develops and recommends medical policy to guide such decisions. Recommends intervention strategies or programs to rectify identified problems.
- Participate in retrospective review of problem areas identified from summary data of paid claims, admission, authorization logs, grievance process, and other sources where policy, utilization, or quality issues are involved.
- Recommend intervention strategies or programs to rectify identified problems.
- Actively participates in the Region's medical staff organization. Develops and maintains relationships with all credentialed staff by participation in medical staff meetings.
- Develop and maintain current knowledge of laws and regulations governing medical practice in the State of Alaska.
- Implement care/services that recognize age/diversity specific needs/issues of customers served.
As health care evolves, our team is responding with a vision and core strategy to transform and innovate at scale. PSJH and its affiliates continue to pioneer how care is delivered by sharing one strategic plan designed to improve the health of entire populations by supporting the well-being of each person the organization serves. ABOUT YOU Above all, we are looking for a servant leader whose personal and professional background demonstrates a genuine passion for the mission and core values of Providence Health & Services. You have a style that emphasizes openness, collaboration, visibility, and connectivity. A strong, confident, results-oriented, and decisive leader with the capacity to balance the big picture and strategic perspective with a focus on operations and the details of execution. You can articulate how your work improves healthcare delivery in the communities that we serve.
- MD/DO degree from an accredited program.
- Formal management training and experience in Quality Management and Resource Management in health care organizations such as PSO and/or Health Plans required. Minimum of five to ten years medical practice experience in a physician group practice or clinic setting. Clinic Medical Director Experience required. Exemplary medical practice history as attested by peers.
- Board certified in appropriate specialty. Licensed in State of Alaska in medical specialty.
- A Master’s Degree in Health Care Management preferred (MBA or equivalent).
- Successful experience with and advocate of managed health care delivery systems and philosophy preferred.