SHSMD Career Center

The per diem Medical Director provides medical leadership and has responsibility for Health-care-related management oversight activities including Utilization Management, Network Management, Quality Improvement. Responsibilities include facilitation of evidence-based and cost-effective professional and institutional services to our membership through oversight of day to day utilization management operations of clinical and non-clinical leaders to ensure compliance with legal and requirements.  May participate in various committees to support performance improvement, improve quality of medical care and the physician and patient experience . Engages physicians to promote relationships and alignment with organizational goals.

Essentials Functions:

Strategic:

• Collaborates with Chief Medical Officer (CMO) and Senior Leadership to implement strategic plans to achieve the company mission and vision.
• Collaborates with director of clinical pharmacy services to support utilization of most clinically and cost effective medications including infusions, injections and generics.
• Acts as clinical support for team to reduce inappropriate emergency department and urgent care utilization.
• Collaborates with team members supporting chronic disease programs as needed.
• Collaborates with team members of programs to achieve preventative care targets as needed.
• Collaborates with contracting, medical management and leadership on incentives, metrics, clinical programs to improve the quality of care provided to our members along with decreasing costs.

Operations:

• Oversees the clinical decision making and Utilization Management/Case Management/Disease Management programs with a focus on adherence to best practices and value-based care.
• Oversees concurrent review team with attention to average daily census and length of stay in contracted and non-contracted hospital facilities, Long-Term Acute Care (LTAC) facilities, Sub-Acute facilities, Skilled Nursing Facilities and Rehabilitation facilities.
• Oversees elective surgery costs, volume and facilities.
• Oversees medical specialty utilization and costs.
• Oversees patient steerage to preferred facilities.
• Engages with network physicians with regard to the cost, clinical appropriateness and authorizations. 
• Oversees the management of tertiary care referrals and utilization.
• May participate in GNP and MCMF committees as needed or directed (e.g. Quality, utilization management, credentialing, etc.)
• Supports the high-risk patient care team in their management of complex or high-cost members, end-of-life care as well as appropriate utilization of hospice and palliative care services.
• Promotes system-wide efforts to improve the quality of care to all patients through physician education, relationships, and direction to appropriate clinical support.
• Participates in peer review, credentialing, QI department and grievances/appeals and HCC coding initiatives and implementation of best practices as needed.
• Assists in managing and maintaining an effective network through relationship-building and educating IPA physicians.