The Medical Director is an essential member of the medical team, focused on clinical decision-making and support for inpatient services in terms of utilization management, care management, and health improvement (quality improvement) with a focus on cost-effective utilization of services. The Medical Director will coordinate member care with our health plans and assist in the flow of clinical information between CHCN clinics, hospitals, emergency departments, specialists, and other providers of care for CHCN’s health center patients. The MD will also assist the CMO and management team in the integration of the Care Transitions work into the development and clinical support of CHCN’s community health strategy. The MD is also an integral part of the Care Neighborhood team, providing medical education and clinical guidance for the interdisciplinary team.
ESSENTIAL POSITION RESULTS
The essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks and responsibilities. Employees may perform other duties as assigned.
Assumes primary responsibility for the utilization management for in-patient care, determining medical necessity, interpreting benefits and limitations, consulting with providers and supporting the in-patient nurse team in their work. Leads weekly clinical rounds with CHCN nurses and health plans.
Leads the Care Transitions Registered Nurse program with Sutter Health, coordinates monthly meetings with nurses and leadership at Sutter, develops processes for program improvement and efficacy.
Leads work with specialty programs and populations such as (CCS transitions, Sickle Cell collaborative)
Shares responsibility for utilization management decisions for outpatient care: determining medical necessity, interpreting benefits and limitations, consulting with providers. Enhance relationships between UM department and the health centers.
Medical consultant to CHCN’s CME program.
Providing clinical advice and support to Care Neighborhood staff as needed, who support our high-utilizing members with care coordination and health coaching.
Will serve on CHCN’s monthly Medical Directors meetings focused on Utilization Management, Quality Improvement and Practice Sharing.
Represents CHCN with our external community partners, including giving presentations as needed.
Participates in and leads special projects and assignments as requested by Chief Medical Officer.
Attends monthly senior leadership meetings with Alameda Alliance.
Leadership skills and experience.
Sound clinical judgment and ability to evaluate evidence and guidelines around medical treatments.
Excellent communication skills and ability to work well with a team.
Utilization Management experience especially working with complex medical patients; familiarity with Milliman Care Guidelines.
Computer literacy, especially as it involves synthesis of patient care information.
Ability to develop new policies and procedures, training nurses or providers on new skills
.Commitment to underserved populations.
Exceptional time management and prioritization skills
Ability to understand large picture of healthcare landscape while being attentive to project details
Additional Salary Information: Position Title: Medical Director
Reports To: Chief Medical Officer
Status: Part Time Regular (50%-75%)
Internal Number: 3001
About Community Health Center Network
The Community Health Center Network (CHCN), sister organization to the Alameda Health Consortium, is made up of the eight federally qualified community health centers in Alameda County. CHCN functions as the managed care MSO for our health centers, contracting with the Alameda Alliance for Health and Anthem Blue Cross. In order to help our health centers meet their missions of providing the best possible care to their communities, we also provide a broad range of training, technical assistance, quality improvement, information technology, and data analytic services