Organizational Description

The Community Health Center Network (CHCN), sister organization to the Alameda Health Consortium, is made up of the eight federally qualified community health centers in Alameda County. CHCN functions as the managed care services organization (MSO) for our health centers, contracting with the Alameda Alliance for Health and Anthem Blue Cross. In order to help our health centers meet their missions of providing the best possible care to their communities, we also provide a broad range of training, technical assistance, quality improvement, information technology, and data analytic services.

Position Title:UM Medical Director

Department:Clinical Operations

Reports To:Chief Medical Officer

Classification:Exempt

Status: Part Time or Full Time (Flexible 60 to 100%)

Salary Range: $224,200 to $270,108 yearly

Candidate must be willing to have primary residence in California. For licensing and tax purposes, we are unable to hire candidates residing outside of the state of California starting on the date of hire.

POSITION SUMMARY

The Medical Director (MD) is an essential member of the medical team, focused on utilization management, care management, and health improvement (quality improvement) for members in our network. The MD is the primary clinical lead for the in-patient team, providing review for quality assurance, medical necessity, and approving denials. They also support the outpatient team with UM reviews, referrals for basic case management, and consulting on complex authorizations for medical necessity. For both teams, the MD integrates quality improvement efforts based on regulatory needs and internal efficiency efforts. The MD assists the CMO and management team in the integration of the Care Transitions work into the development and clinical support of CHCN’s community health strategy. The MD is also an integral part of the Care Neighborhood team, providing medical education and clinical guidance for the interdisciplinary team. Network quality improvement is an important component of the role; the MD works with the CMO and our QI/Data teams to support improved population health management across the network.

ESSENTIAL POSITION RESULTS

The essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks and responsibilities. Employees may perform other duties as assigned.

• Assumes primary responsibility for the utilization management for inpatient care, determining medical necessity, interpreting benefits and limitations, consulting with providers and supporting the inpatient nurse team in their concurrent review of hospitalized members. Leads weekly clinical rounds with CHCN nurses and health plan guests.

• Leads the Care Transitions Registered Nurse program coordinates monthly meetings with nurses and advocates for the expansion and improvement of the program.

• Leads work with specialty programs and populations such as CCS transitions

• Shares responsibility for utilization management decisions for outpatient care: determining medical necessity, interpreting benefits and limitations, and consulting with providers.

• Enhances relationships between UM department and the health centers.

• Responsible as medical leader to CHCN’s CME program.

• Providing clinical advice and support to Care Neighborhood staff as needed, who support our high-utilizing members with care coordination and health coaching.

• Serves on CHCN’s monthly CMO meetings focused on Utilization Management, Quality Improvement and Practice Sharing.

• Represents CHCN with our external community partners, including giving presentations as needed.

• Participates in and/or leads special projects intended to advance health equity and improve access to care:

oClinical oversight and support for CHCN’s Care Neighborhood Program, a part of CalAIM Enhanced Case Management Program

oClinical and network leadership of the Care Transitions Registered Nurse (CTRN) program, designed to reduce hospital readmissions.

• Attends regular senior leadership meetings with health plans, as needed.

• Other duties as assigned.

SUPERVISORY RESPONSIBILITIES

None.

MINIMUM QUALIFICATIONS

Competencies

• Leadership skills and experience.

• Sound clinical judgment and ability to evaluate evidence and guidelines around medical treatments.

• Excellent communication skills and ability to work well with a team.

• Utilization Management experience especially working with complex medical patients; familiarity with Milliman Care Guidelines.

• Computer literacy, especially as it involves synthesis of patient care information.

• Ability to develop new policies and procedures, training nurses or providers on new skills

• Commitment to underserved populations.

• Exceptional time management and prioritization skills.

• Ability to understand the broader healthcare landscape while being attentive to project details.

Education & Experience

• Active, unrestricted, California medical license and MD/DO from an accredited program in Internal Medicine or Family Medicine. Board certification preferred.

• 5 years clinical experience, preferably with hospital experience.

• Previous managed care experience preferred; supportive of managed care philosophy; able to manage difficult conversations with professional peers related to medical case review.

• 2 years working on a team involved with clinical management, preferably in a leadership role.

• Some travel required; a valid California driver’s license and proof of current auto insurance.

General CHCN Roles

• Fosters an environment that promotes trust and cooperation among clients and staff.

• Enforces policies and procedures, including maintenance of client confidentiality, to ensure that the principles of CHCN are implemented.

• Accountable for participating in decision making processes and understanding the outcome(s).

• Understands the values and principles of CHCN and applies them in work responsibilities.

• Participates in outreach activities, agency advocacy, and serves on ad hoc committees, as requested.

• Attends CHCN and Board of Directors meetings, as required.

CERTIFICATES AND/OR LICENSES

Medical Board of California, Certified Physician

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to sit and use hands to finger, handle, or feel. The employee is frequently required to talk or hear. The employee is frequently required to stand; walk; reach with hands and arms and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 15 pounds. Specific vision abilities required by this job include close vision and ability to adjust focus.

WORKING CONDITIONS AND ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly exposed to an inside environment.

The Community Health Center Network is an Equal Opportunity Employer.