Medical Director

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Hartford, CT

Industry: Healthcare

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5 - 7 years

Posted 57 days ago

This job is no longer available.

MD or DO with Active license (to be obtained within the first year of employment)

Board Certified

Master Degree in Business Administration, Healthcare, and/or Medical Management Preferred

Experience with designing effective population health or value based care models and protocols to decrease inappropriate utilization and/or enhance quality of outcomes.

Experience successfully managing cost of care and quality and negotiating the terms of cost and quality in value based agreements. Ability to review data and translate opportunities into actionable tactics

Five years of healthcare practice and leadership experience preferably involving the ambulatory and inpatient domains.

Demonstrated commitment to patient-centered model of care delivery with proven quality management/improvement record

Familiarity with electronic health records.

Encouraged to still be practicing medicine

Licenses and Certifications MD or DO with Active license Board Certified
The Medical Director of Connecticut Children's Care Network serves as the physician executive accountable for the Connecticut Children's Care Network's value based payer contracts and its shift from fee-for-service to risk. The Medical Director focuses on innovative approaches for improving the quality, efficiency and appropriateness of care delivered to the populations managed by the network. In addition, the Medical Director is responsible for helping to develop and implement an innovative provider engagement strategy across the clinically integrated network as well as implementing a provider performance improvement strategy to drive improved quality and cost efficiency. The Medical Director also is responsible for providing medical expertise and leadership to drive the integration and coordination of care that improves quality cast and outcomes. The Medical Director will be accountable for the providers' adoption of evidence-based medical guidelines and protocols with proper stewardship of resources, analyzing members and population to guide program direction. The Medical Director must be a pediatrician and is encouraged to be clinically active.

ROLE RESPONSIBILITIES

  • Serve as the chief medical advisor to Connecticut Children's Care Network, be directly responsible for medical policy formulation and preparing recommendation to the Board of Managers regarding the policies and effectiveness of quality improvement programs.
  • The medical director must work closely with Connecticut Children's Specialty Group specialists and the Chief Quality Officer (CQO) to help develop quality improvement programs for the network.
  • The medical director must also work with the specialists and the CQO to integrate care network quality programs with clinical effectiveness initiatives, co-management programs and other quality programs in the hospital.
  • The medical director will lead the quality improvement program for the network and its implementation.
  • The medical director will work closely with the Sr. Director of the Connecticut Children's Care Network to develop the network.
  • Monitor and control the appropriate utilization of health care services to achieve high quality outcomes in a cost effective manner.
  • Lead the development and maintain oversight of the Connecticut Children's Care Network and its programs.
  • Develop, implement, evaluate and improve the Plan's HEDIS scores, CAHPS surveys and other quality initiatives.
  • Oversee the integration of community based services, care management programs and integration of providers across the continuum.
  • Provide operational support for other departments including grievances and physician relations.
  • Serve as an advisor and oversee staffing for the following committees of the Board of Managers: Finance and Contracting, Quality and Care Integration, IT/Data, Network Development and Credentialing.
  • Communicate directly with primary care physicians and other referring physicians in order to resolve referral issues, research treatment protocols, solicit advice on problem cases and assist in the development of referral criteria and practice guidelines.
  • Represent Connecticut Children's Care Network in the medical community; obtain support of the participating medical community for the quality improvement programs.
  • Establish and maintain medical relationships with the state and commercial insurance companies.
  • As an Executive Staff member, be an active participant overall in Connecticut Children's Care Network strategic planning and implementation. Work collaboratively with other Executive Management team members of Connecticut Children's to achieve the mission, objectives and strategic priorities of the network.
  • Participate in the improvement of the network performance on a continuous basis.
  • Attend off-site meetings or events as necessary.
  • Perform other related duties as required or assigned.
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