Summary/Objective:

The Senior Medical Director is responsible for leading efforts to develop and implement medical management and performance improvement strategies to ensure success in our existing (Medicare Advantage) as well as net new LOBs. They will also leverage their clinical knowledge and industry expertise to lead our My Health and At Home programs and meet with Primary Care Providers to develop action plans to help improve utilization and provide better health for patients. The Senior Medical Director would also leverage their entrepreneurial and innovative abilities for this position to help enable the company to expand the program into new markets.

This Senior Medical Director must be effective at influencing community physicians and providers, administrative leadership in community practices, and other key practice staff to drive value-based care success. They will support the establishing and hardwiring processes to drive excellence in efficiency of care, and quality for all populations served.

Essential Functions:

• Implement and execute the MyHealth and At Home programs and deliver on program milestones in partnership with CMO and VP of Health Services Operations
  • Development, implementation, and scalability of Remote Patient Monitoring (RPM) pathway and clinical improvements for Complex Case Management (CCM) patients
  • Incorporation of Social and Behavioral Determinants strategy and tactics in addition to the medical management of CCM patients
  • Lead interdisciplinary weekly meetings with the MyHealth Team (MHT)
  • Develop and implement ongoing improvements in MHT to lead to improvements in utilization
  • Direct the integration of the Pharmacy team with the MHT on CCM patients
  • Directing clinical aspects of MyHealth Nurse (MHN) on coordination of care
  • Overseeing clinical aspects of Provision of Care for MyHealth Doctor
  • Accountable for achieving KPIs for the MHT, such as Admissions/1000, Readmission %, and ER/1000 goals
  • Prepare presentation materials for internal and external meetings, such as internal clinical team meetings, PAC meetings, and Medical Expense and Business Review meetings
  • Support all out-of-state/territory expansion efforts and effectuate similar programs and oversight
  • Present MyHealth and At Home programs to various audiences including PCP groups, and Health Plans in existing and new markets/states
  • Develop and implement the ability of the MyHealth and At Home programs to be implemented for Health Plans in populations beyond our MSO population
• Serves as liaison to external groups on Health Services programs to promote effective collaboration and communication
• Maintain collaborative team relationships with peers and colleagues in order to effectively contribute to the achievement of goals, and to foster a positive work environment
• Collaborate in the expansion of the Clinical Value Proposition for the Better Health Group. Works with leadership to identify areas of concern and address opportunities for improvement
• Establish a peer level credibility with physicians and providers across the markets we serve
• Respond to provider/administrator/practice requests for (but not limited to):
  • Value-based care input on leading practices for achieving success measures 
  • Design, prepare, and participate in Town Halls
  • Present and facilitate Provider Advisory Committee meetings
• Assisting in offering constructive feedback to providers to improve performance
  • Collaborate with the Senior Manager Analytics to identify reasons for off-track PCPs in Florida and other states
  • Conduct office or teleconference visits for assigned variance PCPs in Florida and other states to improve their utilization and cost performance. Meet at least monthly assigned PCPs
  • Review drivers of off-track Part A, B, and D utilization with PCPs running higher than benchmark performance. Display utilization reports, and cases as well as set target goals and monitor performance improvement over serial visits. Meet monthly or more frequently
• Ability to understand stakeholder concerns and frame issues/proposals to influence decision-making
• Experience using a metrics-driven approach to analyze cost, quality, and satisfaction data to drive clinical strategy and program redesign
• Other duties, as assigned

Required Education/Experience: 

• Medical Degree from an accredited medical school
• Internal medicine, Family medicine, or Geriatrics are strongly preferred
• Licensed to practice medicine in the state of Florida
• Licensure to be obtained for additional states or territories as required
• Board Certified in a specialty recognized by the American Board of Specialties (ABMS)
• 3 or more years of clinical experience
• 3 or more years of managed care experience
• Experience in Utilization Management and Physician Improvement Programs
• Experience in Medicare Advantage
• Experience in Value-Based model of care
• Experience in leadership roles and project management
• Experience working with high-performing teams and leading organizational change efforts
• Experience and expertise in medical cost-reduction activities
• Understanding of medical analytics and reporting
• Provide medical knowledge to facilitate the resolution of complex issues and required decisions
• Working knowledge of medical policy and application of criteria
• Ability to manage multiple priorities in an expedient and decisive manner
• Experience and passion for primary care excellence are required
• Ability to manage difficult peer-to-peer situations arising from medical care reviews
• Must possess excellent communication skills to interface with providers, team members, and health plans
• Willingness to be both a strategic leader and hands-on problem solver
• Strong interpersonal and presentation skills
• Appreciation of cultural diversity and sensitivity toward target populations

Additional Eligibility and Qualifications:

• Experience with Clinical Operations and Medicare
• Understanding of Healthcare Best Practices ranging from Clinical to Hospital processes and procedures
• Understanding of the terminology, techniques, and reimbursement mechanisms employed in the delivery of healthcare including, but not limited to clinical coding (ICD-10, CPT, and DRG), medical record review, population health, and EMRs
• Ability to use Electronic Medical Record (EMR) system to review Patient records
• Proficiency in Medicare Risk Adjustment
• Effective communication and interpersonal skills
• Proficiency in Google Suite products such as Google Docs, Google Sheets, etc.
• Valid Florida Driver's License
• Proven track record of achieving results

Supervisory Responsibility:

• Responsible for the MyHealth Team
• Report directly to the CMO

Work Environment:

• This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, and fax machines

Position Type/ Expected Hours of Work:

• This is a full-time position and core hours of work and days are Monday to Friday 8:00 a.m. - 5:00 p.m.
• 3 days/week at HQ in Tampa are required, overall travel is approximately 35%
• Extended hours to accommodate urgent and emergent tasks will be expected

• Occasional travel to variance Physician, Specialist, and Hospitalist locations
• Approximately 35% of travel is required to existing and new markets/States

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