Objective and Summary:

Groups is a rapidly growing, mission-driven healthcare company that provides affordable, evidence-based treatment for Opioid Use Disorder. Our model uses two of the most powerful tools for recovery: group therapy and medication for opioid use disorder with buprenorphine-naloxone. Our approach takes the best parts of mutual aid groups (support, and community) and combines them with the latest medical science and technology. At Groups, our medical providers are a key component of our multidisciplinary care team that also includes substance abuse counselors, office managers and recovery support specialists. Our medical leadership provides a mixture of direct member care and administrative/leadership responsibilities.

As the Member Access Medical Director, you will play a crucial role in ensuring the success of our care delivery model within the Member Access Team by providing medical oversight and guidance to our team of Providers. Working closely with the Director of Provider Management, you will collaborate to streamline processes, enhance efficiency, and maintain consistency in documentation and charting within the team.

This role reports to the Regional Vice President of Care Delivery.

Essential Functions:

Reasonable accommodation may be made to enable individuals with disabilities to perform these essential functions.

Act as a point of contact for escalations from Member Access Providers, providing timely collaboration and support to address complex cases or medical concerns while being an expert on Groups clinical and operational policies, procedures, and manuals. Be able to navigate complex clinical situations in a manner consistent with Groups' philosophy and culture.
• Complete supervision and ensure documentation and charting within the Member Access Team adhere to established standards of efficiency, accuracy, and completeness, in alignment with regulatory requirements and organizational policies.
• Be available to assess and intervene in high-risk or urgent member cases, offering expert medical guidance and assistance as needed to ensure optimal patient outcomes.
• Participate in regular meetings with Member Access Providers to address medical process concerns, identify areas for improvement, and implement strategies to enhance the effectiveness and quality of care delivery.
• Foster a culture of collaboration, open communication, and continuous learning within the Member Access Team, working closely with other stakeholders to promote interdisciplinary cooperation and shared best practices.
• Foster a culture of collaboration and continuous improvement between the member access team and the field teams who receive new members after admission. Work to ensure seamless handoffs and excellent member-outcomes during this risky time of transition.
• Help to gather, organize and break-out available data to find trends, breakpoints and potential skill gaps to be used to drive the Member Access team to successful KPI.
• Adhere to all clinical policies and procedures as outlined to Determine each member's medical necessity and appropriateness for treatment pursuant to applicable clinical models, policies and procedures, and manuals (e.g., Recovery System Manual) as required by Groups Recover Together. Prescribe medications for oud treatment and, where appropriate, other approved medications to treat withdrawal symptoms, in a manner consistent with Recover Together policies and procedures and the Groups Recovery System Manual.
• Maintain a limited schedule of patients where licensing/certification applies and serves as their dedicated provider, reviewing their care plan and medication management at each monthly visit or more often, as necessary or required by state regulations.
• Be available by phone/email to discuss patients' medical issues in between visits.
• Provide as needed coverage for makeup groups and one-to-one follow-up sessions.
• Provide, as needed, cross-coverage for colleagues and answers to medical questions when clinical cases are escalated for your review and Serve as the primary backstop for all medical concerns; be available for escalations (via phone or email).
• Maintain patient records in confidence and complete records as required by HIPAA and other applicable federal/state laws, rules, or regulations/company policies regarding medical records.
• Partner with Director of Member Access Providers to deliver leadership on continuous improvement of medical service delivery across the organization
• Work with the medical leadership team to pilot new initiatives aimed at improving clinical outcomes and experience.
• Assist with onboarding, training, and support of new providers on the Member Access Team.
• Serve as collaborating physician for assigned NP/PA providers and/or site medical director for specified sites, if applicable.
• Support ongoing Groups' trainings, performance improvement activities, and change management activities within the Member Access Team.
• Provide support in tandem with the Director of Provider Management pertaining to ongoing medical training and education for Member Access providers.
• Assist with roll-out of new protocols, workflows, and care pathways where needed.

Assist with other duties as assigned by Regional Vice President of Care Delivery or Chief Outcomes and Medical Officer.

Qualifications & Requirements:

• Physician (MD/DO) with active medical license and appropriate behavioral health or addiction medicine NPI taxonomy (or willingness to adjust primary or secondary NPI taxonomy).
• Addiction Medicine board certified or board eligible strongly preferred.
• At least 5 years of medical leadership or management experience either during or after residency training.
• Active medical license in good standing in a state where Groups Recover Together operates and willingness and ability to obtain additional licenses in other states (no background issues that could limit state licensing or credentialing).
• Membership in the Interstate Medical Licensing Compact or willingness to join.
• Willingness and ability to become credentialed with all government and private health plans with whom Groups Recover Together is in network.
• At least 1 year of experience managing OUD with buprenorphine using a low-barrier philosophy.
• At least 1 year experience working in a team-based-care setting with behavioral health providers (therapists, social workers, case managers, etc).
• At least 2 years experience working with a similar member population (primarily medicaid, high burden of SDOH, SUD, and mental health diagnoses).
• Access to reliable internet and telephone services, specifically 10M download and 5M upload package or higher, as well as a strong WiFi signal from your remote work location.
• Must meet pre-employment requirements and maintain all applicable state and job-related guidelines for background screening. Depending on state-specific requirements, this may include fingerprinting, drug testing, health screening, COVID vaccination verification, CPR/Basic First Aid and license/credential verifications.

Physical Requirements & Working Conditions:

These physical demands are representative of the physical requirements necessary for an employee to successfully perform the essential functions of the job. Reasonable accommodation can be made to enable people with disabilities; these are made on a case-by-case basis.

• While performing the responsibilities of the role, the employee is required to talk and hear. The employee is often required to sit and use his or her hands and fingers. The employee is occasionally required to stand, walk, reach with arms and hands, climb or balance, and to stoop, kneel, crouch or crawl. Vision abilities required by this job include close vision.
• Limitations and Disclaimer:
• The above job description is meant to describe the general nature and level of work being performed; it is not intended to be construed as an exhaustive list of all responsibilities, duties and skills required for the position.

Limitations and Disclaimer:

The above job description is meant to describe the general nature and level of work being performed; it is not intended to be construed as an exhaustive list of all responsibilities, duties and skills required for the position. Other duties may be assigned from time to time.

Equal Employment Opportunity Statement:

Groups is an equal opportunity employer committed to diversity and inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration without regard to race, color, gender, gender identity or expression, sex, sexual orientation, transgender status, gender dysphoria, national origin, age, religion, disability, military and veteran status, marital or parental status, citizenship status, genetic information or any other factor which cannot lawfully be used as a basis for an employment decision.