Medical Director Physical Health

Phoenix AZ 85034

Job Description

Based in Arizona, works collaboratively with Magellan medical leadership, senior leadership of MCC of AZ and Magellan Complete Care to achieve overall company goals of growth, financial performance including cost of care and clinical quality improvement. Responsible for leading and managing the local physicians providing Utilization Management reviews and leading rounds. Provides strategic oversight of national comprehensive medical policies and programs to include contributions to the development, implementation and evaluation of the clinical and cost effectiveness of medical services. Must also collaborate with Magellan Rx colleagues to this end as well. Serves as the primary medical representative on behalf of the MCC of AZ.
Manages physicians who manage medical relationships with state government agencies, provider network organizations and other physical and behavioral health entities to facilitate the delivery of appropriate quality care. In tight partnership with the local physicians, oversees the national clinical quality program for MCC of AZ, medical management, utilization management, care management and disease management processes and outcomes and provides oversight of the overall clinical program and strategic initiatives for enterprise consistency and integrity. Provides direct management to Adult and Children's Healthcare Administrators for both physical and behavioral health services.
  • Works closely with the Magellan Medical leadership, members of the national corporate clinical executive team, and most tightly with the MCC of AZ leadership team to create and implement national medical and clinical policy and programs for the designated business unit region.
  • Interfaces with National and State medical leadership, both in standing meetings and as needed, to discuss emerging issues, improvement in metrics, and strategic plans.
  • Provides medical leadership, oversight, consultation and supervision for the designated business unit region including the National and Local Quality Improvement (QI) Program and Utilization Management (UM) Program. Also provides strategic direction and implementation assistance for Disease and Care management programs nationally. Identifies clinical trends and best practices and partners with Operations Clinical SVP and/or VP and other cross functional teams to develop and adopt said best practices to improve the clinical and cost effectiveness of patient services. This includes working with the Network and Quality national leadership to develop and deploy best practice PCMH, ACO and value based purchasing efforts in the region.
  • Participates with the VP, Medical Policy and Programs in the development, implementation and interpretation of medical/clinical policy for the designated business unit (including Medical Necessity Criteria, Clinical Practice Guidelines and New Technology Assessments). This includes ensuring the the medical directors are applying the medical/clinical policies to their respective areas of oversight.
  • Responsible for ensuring effective deployment of medical and clinical resources and consistency across the service systems including ensuring that critical functions are developed and deployed as specific needs arise. Responsible for driving to resolution short term, cross functional issues adversely impacting clinical outcomes.
  • Will also be involved in, clinical program development across the service spectrum; implementation and interpretation of clinical and medical policies and procedures; national and local Physician recruitment (including oversight of on-boarding and training); national provider profile design and interpretation; oversight of all utilization management; care management, disease management and quality management activities; continuous assessment and improvement of the quality of care provided to behavioral healthy recipients; and development and implementation of the National and Local QM and UM plans.
  • Responsible for managing all clients covered in Arizona, as well as management of all levels of Medical Directors serving those geographic populations. Manages the work of local Medical Directors serving those geographic populations. Manages the work of local medical Directors in providing cost effective and quality care management services. Designs appropriate infrastructure and staffing resources under the Adult and Children's Healthcare Administrators in order to ensure that expertise for both physical and behavioral health services are available and integrated within the organization.
  • Responsible for planning and scheduling staff, ensuring full staff coverage for standard work week and after hours coverage.
  • Responsible for cost of care of health plans under the direction of sr. leadership, including reviewing data, interpreting data, and applying data for operational and cost of care interventions.
  • Interfaces with clients within the region and is expected to divide opportunities for interactions with health plans, state agencies and other stakeholders within the region.
  • Participates in the RFP process for new business opportunities in the region. Provides overall clinical construct and direction for RFP responses for the designated business unit region to ensure the clinical integrity of serving complex populations.

General Job Information

Title

Medical Director Physical Health

Grade

36

Job Family

Clinical Services Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

7/10/2019

Date Requisition Created

7/10/2019

Work Experience

Medical

Education

DO (Required), MD (Required)

License and Certifications - Required

DO - Physician, State Licensure and Board Certified (ABMS or Specialty Board) - Physician, MD - Physician, State Licensure and Board Certified (ABMS or Specialty Board) - Physician

License and Certifications - Preferred

Other Job Requirements

Responsibilities

  • Post residency experience of at least 5 years involving substantial direct patient care during this period at multiple levels of care. Clinical experience pertinent to the patient population(s) being managed, specifically complex populations, Medicaid and/or medicare.
  • Unrestricted current and valid license or certification to practice medicine in Arizona.
  • Managed care experience required, as provider and/or manager of care. Utilization Review and Care Management experience required.
  • Graduate of an American or Canadian medical school accredited by the Accreditation Council for medical Education (ACME) or equivalent training in a foreign medical school with successful completion of the ECFMG and FLEX examinations. Full training in a residency program in the United States or Canada that is approved by the ACGME.
  • Clinical program development and strategic planning preferred. Accreditation experience (NCQA, AAHCC/URAC) preferred.
  • Must be a licensed DO or MD and Board Certified (ABMS or Specialty Board)

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

“I receive a high level of support from our Senior Management Team to execute on our vision. They are always accessible and approachable, something I’ve found to be very unique to Magellan.”