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Executive Director, Lead Medical Director

Executive Director, Lead Medical Director

Triton Health SystemsBirmingham, AL, US
30+ days ago
Job type
  • Full-time
Job description

Job Description

Job Description

Executive Director, Lead Medical Director

Location : Birmingham, AL

Why VIVA HEALTH?

VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.

VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.

Benefits

  • Comprehensive Health, Vision, and Dental Coverage
  • 401(k) Savings Plan with company match and immediate vesting
  • Paid Time Off (PTO)
  • 9 Paid Holidays annually plus a Floating Holiday to use as you choose
  • Tuition Assistance
  • Flexible Spending Accounts
  • Healthcare Reimbursement Account
  • Paid Parental Leave
  • Community Service Time Off
  • Life Insurance and Disability Coverage
  • Employee Wellness Program
  • Training and Development Programs to develop new skills and reach career goals
  • Employee Assistance Program

See more about the benefits of working at Viva Health - https : / / www.vivahealth.com / careers / benefits

Job Description

The Executive Director, Lead Medical Director is responsible for providing direction and support on medical, pharmaceutical, and quality issues related to the members of VIVA HEALTH. This position will oversee the Medical Directors and be involved in coordinating coverage for the utilization review team, the case management daily review for acute, transitions of care staff, post-acute care, and pharmacy redeterminations.

This role in collaboration with the Vice President, Clinical Services will co-chair the Utilization Management / Quality Improvement (UM / QI) committee, Credentialing Committee, and serve on other committees as needed. This position will prepare utilization data, high-cost trending, and collaborate with the facility partners at the quarterly Joint Operating Committee meetings and monthly clinical calls.

Key Responsibilities

  • Provide direction and support while offering a quality medical perspective to the Medical Management department.
  • Assist in developing and implementing operational processes, including but not limited to workflow changes, departmental documentation, and staff education to maximize departmental efficiency.
  • Assist with the relationships between VIVA HEALTH and participating network physicians. This includes initiating discussions with physicians to make appropriate medical review decisions and responding to requests for discussion of cases, approval / denial decisions, etc.
  • Provide assistance to the Provider Services department for physician education initiatives as needed.
  • Provide support to internal staff in the Quality, Pharmacy, and Credentialing departments to create sound policies, procedures, and departmental goals. Act as Chair for corresponding committees when asked by the Vice President, Clinical Services. Aid in oversight and audits as needed.
  • Administer best practices guidelines and provide guidance to Case Management for concurrent review.
  • Assist in the development of medical necessity criteria on both new and / or uncommonly used drugs for use in coverage and denial decisions.
  • Serve as a subject matter expert in the grievance process and provide official signoff for all denial decisions.
  • Formulate and recommend cost containment ideas for patients in either an ambulatory or hospital setting. Provide internal decision support regarding medical necessity and over / under utilization of medical services in the VIVA HEALTH member population.
  • Provide on-call coverage and assistance to nurses outside normal business hours to ensure required turnaround times are met.
  • Maintain working knowledge of VIVA HEALTH Certificates of Coverage for its unique member populations and assist in ongoing document development.

    • REQUIRED QUALIFICATIONS :

  • Medical degree from an accredited University
  • 10 or more years clinical experience in direct patient care
  • Management or Supervisory experience
  • Current Physician license in good standing in the State of Alabama
  • Board Certified Physician
  • Ability to identify problems, collect data, establish facts, and draw valid conclusions
  • Strong analytical, time management, and organizational skills; Ability to integrate diverse objectives with a high level of attention to detail
  • Ability to read, analyze, and interpret various materials and effectively present information to individuals and groups; Effective oral and written communication skills
  • Proficient in basic mathematical skills; Ability to read and explain graphs and charts
  • Ability to read, analyze, and interpret procedures as well as government regulations; Ability to effectively present information and be persuasive in both one-on-one and group settings
  • Ability to maintain favorable public relations while remaining sensitive to a variety of cultural, social, and educational backgrounds; Culturally sensitive with prior experience working with diverse groups on personal and financial issues; Skilled in discussion facilitation and problem solving
  • Basic PC skills, including but not limited to Microsoft Word and Excel proficiency; Ability to use Electronic Health Record
  • Knowledge of information and techniques needed to diagnose and treat human injuries, diseases, and deformities; This includes symptoms, treatment alternatives, drug properties and interactions, and preventative health care measures
  • Knowledge of general medical principles and practices; Ability to assess and problem solve while working with a healthcare team; Ability to remain calm under stress
  • Administrative and supervisory skills

    • PREFERRED QUALIFICATIONS :

  • Experience in both inpatient and outpatient clinical settings
  • Experience in managed care and / or population health
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