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About the Role
The Medical Director provides professional leadership and direction to the utilization & cost management and clinical quality management functions of Martin’s Point’s Health Plans. They work collaboratively with other plan functions and assist in program planning, quality management, and external relationships.
Responsibilities
- Serves as a key implementer of the Health Plan’s Triple Aim strategy, driving the cost management component.
- Manages health plan medical costs by assuring clinically appropriate health care delivery for health plan products and services.
- Performs medical necessity reviews of requests for health plan-covered services and reviews disputes and appeals for clinical appropriateness.
- Contributes to case reviews to ensure the quality and safety of care and services delivered to members.
- Assists in the construction of annual Utilization Management, Care Management, and Disease Management Program Descriptions and ensures programs meet accreditation and regulatory standards.
- Participates in medical policy review and policy development.
- Works with Informatics, Network Management, and Medical Economics to assess Network providers regarding cost management and develops communication plans for outliers.
- Develops an in-depth understanding of ACOs and contributes to their management and strategic deployment.
- Provides support to Health Plan risk adjustment activities.
- Is conversant with Health Plan goals and strategic initiatives, including utilization and cost management goals, MLR, inpatient/SNF days, and clinical quality improvement objectives.
Requirements
- MD/DO degree required.
- Active and unrestricted license to practice medicine in Maine or New Hampshire, or another U.S. state with eligibility for additional licensure.
- Board certified physician with post-graduate experience in direct patient care.
- Medical leadership in, or focused activity of, a Health Plan (preferred).
- 2-5 years of experience in utilization management in a health plan setting (preferred).
- Knowledge of process improvement tools.
- Deep knowledge and practical understanding of Health Care systems and Managed Care concepts.
- Knowledge and deep commitment to performance-based Health Plan systems.
- Good analytic skills with the ability to identify meaningful trends and targets for improvement.
- Excellent interpersonal skills and demonstrated ability to establish rapport and working relationships with providers, service vendors and internal staff.
- Demonstrated ability to manage and develop staff.
- Willingness to explore innovative methods of providing medical management.
- Supports the culture and models the MPHC values.
- This position is not eligible for immigration sponsorship.
Skills
- Analytic skills
- Interpersonal skills
- Staff management and development
Location
- Maine
- New Hampshire
Work Type
- Full-time
Experience Level
- 2-5 years
Education Level
- MD/DO
Salary/Compensations
- $238,389.30 - $294,480.90
Benefits
- Medical insurance
- Dental insurance
- Vision insurance
- Retirement savings with employer contributions
- Paid time off
- Volunteer time off
- Pie day
About the Company
- Martin's Point Health Care is an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond.
- Employees are on a mission to transform our health care system while creating a healthier community.
- Employees enjoy an organizational culture of trust and respect, where values include taking care of ourselves and others, continuous learning, helping each other, and having fun.
- Certified as a "Great Place to Work" since 2015.
Equal Opportunity
- We are an equal opportunity/affirmative action employer.
- Martin's Point complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities.