Medical Director FHPN

Adventist Health System Sunbelt   •  

Maitland, FL

Industry: Healthcare


5 - 7 years

Posted 173 days ago

This job is no longer available.

The Medical Director serves as the leader for advancing physician practice excellence efforts and leads, models, mentors, coaches, trains, engages and aligns physicians to participate in organizational improvement efforts that enhance patient, employer and physician satisfaction.  Serves as a Subject Matter Expert for the Quality and Clinical Documentation Integrity (CDI) portions of the Network’s Clinical Integration (CI) Program to provide direction and recommendations to the President with analysis and recommendations for the inclusion and exclusion of measures to ensure the program is capturing the key elements that drive improvement in patient safety, quality, and total cost of care.  The CI program intersects with other care redesign programs within FH CFD as the primary driver of physician engagement in projects and programs that benefit FHPN and the Health System. Key role in improving utilization, standardization of physician practice, and evidence based quality improvement.  Lead clinician in managing the Quality of care and CDI within the Network.  Interacts with physician participants, Network Leadership and Medical Directors of payers as needed to discuss the needs of patients, improve quality performance and standards in the Network.  Leads critical strategic initiatives regarding federal, state, and private payer quality programs.  Assist in the development of physician relationships and physician engagement within the Network through consistent, positive messaging and education around the principles of Value Based Care/Population health and core competencies necessary to succeed, and for stimulating growth of FHPN and a maturation of an Integrated Delivery Network.  Provide leadership in medical management across the continuum, of care by working through the member physicians and hospital clinicians.

Specific job duties include:

  • As a senior medical member of the Network Leadership, provides input into the strategic planning and resource allocationprocesses of the Network to meet strategic and operational objectives.
  • With the President of FHPN, investigates and studies new developments in evidence -based medical practice techniques and technology.  Initiates discussion regarding the implementation of new procedures and technologies and participates in the development and implementation of new patient care programs.
  • Oversees the implementation of identified systems/processes in order to improve Quality and CDI
  • Promotes physician integration and inpatient/outpatient alignment to support managed care.  Supports medical necessity review of referrals and interfaces with payer Medical Directors on various issues as needed
  • Reviews data sources in connection with utilization review and quality improvement activities and performance indicator review s of ambulatory practice patterns as needed in collaboration with the appropriate Network Leadership
  • Acts as internal consultant and subject matter expert to medical groups around quality and CDI.  Resolves physician member issues/inquiries in collaboration and conjunction with Network Leadership
  • Participates in Network Leadership events as needed and directed from time to time by the President of FHPN and acts as a liaison to Hospital and Health Systems Administration to ensure alignment within the Network
  • Participates on key hospital and Network committees as assigned by the President of FHPN to facilitate the strategic alignment of system-wide initiatives.
  • Responsible for overall direction of Quality for independent and employed physicians.
  • Endorses and provides guidance for quality studies, as driven by payer parameters.
  • Works with Physicians (directly or indirectly) to enhance and accelerate development and implementation of clinical quality initiatives focused on reducing patient risk, improving health outcomes, and developing innovative care models
  • Identifies and provides strategic direction for quality initiatives based on analysis and information from multiple sources
  • Acts as a mentor and consultant in the development of physicians within FHPN.
  • Develops quality improvement program in conjunction with FHPN Quality committee
  • Promotes quality improvement and monitors quality performance, performs peer review and occurrences involving professional judgement and behavior.
  • In conjunction with Network leadership, identifies physicians who are not achieving benchmark measures on FHPN indices, and develops strategies to improve performance
  • Reviews CI program to determine inclusion/exclusion of measures and make appropriate recommendations to Network Leadership
  • Serves as physician subject matter expert to determine evidence supporting the inclusion/exclusion and impact of measures in the CI program.
  • Endorses and facilitates care coordination education for Network physicians in collaboration with the Medical Director of CM and PHSO VP of Care management to assure care gap closure and quality performance improvements.
  • Works with Network Leadership and Hospital stakeholders to ensure quality and managed care initiatives are rolled out effectively
  • Reviews the delivery of services and care provided to patients for conformance to professional standards as determined by the appropriate Network committees.
  • Recommends and as directed develops interdisciplinary strategies and action plans to ensure integrated and coordinated care across the delivery system, assuring the provision of high quality care to patients and families.
  • Responsible for overall Network performance on CDI as measured by closing of coding gaps, documentation of burden of illness in compliance with program standards and regulations.
  • Serves as the physician subject matter expert on CDI for the Network and drives performance excellence in CDI. 
  • Collaborates with PHSO, Network leadership and others to design implement and monitor standard CDI process within the network.
  • Collaborates with PHSO and Network leadership to educate member participants regarding CDI, HCC, RAF and associated documentation requirements to accurately reflect burden of illness of patients in relevant populations.
  • Interacts with appropriate analytic resources from HIS, PHSO, payers to accomplish goals of Network’s comprehensive CDI program.
  • Collaborates across the Network and Region and with various IT, analytics resources to assure adequate capture of appropriately documented burden of illness in relevant populations.\

    Education Requirements:

    • Doctor of medicine or doctor of osteopathic medicine
    • Minimum five years’ clinical practice experience, preferably in a primary care specialty
    • Leadership experience in a managed care setting; for example, MSO, large risk-bearing IPA, or complex delivery environment that is “at risk” for medical care.
    • Experience building external relationships with physicians
    • Advanced degree or additional education in areas such as business, medical management, public health, or related fields.(Preferred)