Position Purpose: 

Assist the Chief Care Officer to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. Provides direct high quality patient care in their respective specialty to patients. Collaborates and works effectively with other providers and staff to provide effective team based medical care.

Essential Functions: 

Demonstrates behaviors that are important to the success of the organization and that support and uphold ChapCare’s Mission, Vision and core values.  

Uses effective communication skills with patients and staff. Follows proper organizational communication lines to address matters pertaining to job functions including proper reporting relationships.

Provides medical leadership of business unit for utilization management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review, quality assurance, medical review of complex patients, and medical services. Supports effective implementation of performance improvement initiatives.  

Assists Chief Care Officer in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members. Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, accreditation requirements and scope of practice.  

Assists the Chief Care Officer in the functioning of the physician committees including committee structure, processes, and membership. Oversees the activities of physicians and mid-levels assigned to business unit. Utilizes the services of medical, pharmacy, behavior health, patient education & wellness programs, consultants for reviewing complex cases and medical necessity appeals. Participates in provider network development and new market expansion as appropriate.  

 Expectations: 

· Trust will continue to have increased between administration and the provider staff and there will be a stronger sense of collaboration and partnership in the patient care enterprise.  

· Effective working relationship with provider staff leaders.  

· Clinical excellence will be further recognized and affirmed through quantifiable metrics in performance.  

· There should be a stronger sense that Administration is mindful of provider issues when setting direction and policy.  

· There will be measurable improvement in clinical staff and patient satisfaction.  

· Be an advocate for the provider staff vantage point in promoting collaboration with Administration and the Chief Care Manager.