The Medical Director is responsible for the oversight of Clinical Risk Adjustment activities including staff performance, fiscal reporting, and documentation management. The duties include but are not limited to recruitment, retention, supervision, and mentoring. The medical director provides leadership and fosters cooperation, collaboration, and collegiality among their team members and our affiliate colleagues. Ensures a prominent level of cooperation and communication among their team members. The incumbent is personally responsible for promoting and maintaining excellence and integrity in teaching, research, patient care, and enhancing the quality of training. Lead and participate in strategic planning efforts.
In charge of the orientation, education, and training of all adult primary care providers for clinical documentation quality in population health management of assigned patients. Maintaining the integrity of the department by proper utilization of fiscal resources, and personnel matters Attend/Lead clinic level meetings to present material and learning opportunities for improving patient outcomes and program management (such as Quality, STARs, Clinical Documentation, comprehensive care, and care coordination, among others).
- Review charts regularly to aid in the education process, and discover opportunities for continuous improvement of patient outcomes. Meet expected productivity in chart review to inform programming needs.
- Develop ongoing chart review processes to ensure continued high standards in chart hygiene, clinical judgment, and completeness, as well as aid in developing and monitoring inter-reviewer reliability testing.
- Provide mentoring to providers on managed care and professional development issues in order to support improved provider engagement and retention.
- Shadow and coach providers and deliver feedback in a constructive manner that leads to improved provider engagement and enhanced clinical behavior.
- Analyze data, prepare, and implement action plans to help improve provider and clinical performance.
- Analyze practice patterns (data, profiling, documentation), strategize, and coordinate with Medical Directors to implement effective changes for improved performance.
Coordinate implementation of clinical programs. Programs include, but are not limited to, training and educational activities and coordination of routine and random targeted quality audits and concurrent follow-up feedback.
Coordinate with clinical leadership to ensure the clinical aspects and best practices are communicated to the group and affiliated providers. Track and support interventions for improved quality outcomes. Assist with provider recruitment and new provider onboarding. Assist in identifying root cause issues that affect care outcomes and help with implementation and monitoring of corrective actions for practicing providers. Participate in peer review and risk management activities. Other duties as assigned by Company.
Expectations of Physician in providing Medical Director services include, but are not be limited to, regularly attending LEAD provider meetings with CMO and other Medical Directors, meetings, and provider education programming and other leadership meetings as assigned. Take a leadership role in provider meetings, supporting adult primary care and specialty clinical initiatives and operations. Administrative work as directed by Company, to include but not limited to, chart review, clinical initiatives, and operations.
Continue delivering superior clinical performance as described and measured by Company in the clinic(s) as needed while demonstrating high patient engagement through patient satisfaction results.
Others as established by Company from time to time.
- Must have or be eligible to have a current and unrestricted Nevada medical license
- Minimum of 5 years of work experience related to clinical documentation, clinical risk adjustment, and patient population health management.
- Strong communication and interpersonal skills
- Board Certified in Internal Medicine, Family Practice, or another primary care specialty
- Current Nevada DEA certificate required prior to start date
- Current Nevada Pharmacy license required prior to start date
- BLS/ACLS certification prior to start date
Experience in Coding and Risk Adjustment preferred