Responsible for providing the means, structure, and environment to most effectively and efficaciously utilize the resources that are available to ensure that all enrolled members have access to appropriate medical care, and are provided with opportunities for health promotion and health maintenance as an administration of their individual Health Plan benefits in conjunction with additional community resources identified as meeting member care needs.
- Assumes oversight responsibility for all components of medical management.
- Assumes responsibility for the administration of all medical activities.
- Oversees and participates in the development, documentation, implementation, and interpretation of local medical policies and procedures.
- Clinical leader for oversight and support of all Care Management activities
- Leadership of the Interdisciplinary Care Team Meetings (ICT)
- Oversees provider education, in-service training and provider orientation.
- Participate in Medical Director Conferences.
- Remain current in the knowledge of geriatrics, utilization management, quality management, managed care principals and new clinical developments and technologies.
- Interact with local attending physicians on application of the Landmark Health model and issues regarding medical practice.
- Support the program within the community and assist in the development of local business opportunities for furthering the cause of the program.
- As the community representative, assist Landmark Health in providing quality medical care and interact with colleagues, families and patients in a professional manner.
- Resolve conflicts between physicians and among physicians, members, and Landmark Health personnel.
- Meet/confer periodically via telephone or in person, with the Program Director, VP of Medical Services and other Landmark Health management regarding local issues including patient care plans and authorizations for service.
- Provide Primary Care Physician Services to members in the event that the member’s PCP is unavailable.
- Maintain HIPAA compliancy.
- Other duties as assigned.
Medical Doctor currently licensed to practice without restriction in the state of practice, and has met or exceeded all the credentialing requirements of a provider within the provider panel. Current in the knowledge of geriatrics, utilization management, quality management, managed care principals and new clinical developments and technologies.