The Medical Director will partner with cross-functional teams and senior leaders to ensure that naviHealth leads the industry in innovative health management strategies and is considered an expert in the field of post-acute care. The role is a physician leader with a proven track record of innovation, achievement of measurable goals, and exceptional clinical competencies. They take a proactive approach to the marketplace and are responsible for continuously reshaping naviHealth’s corporate-wide strategies.
- Provide daily utilization oversight and external communication with network physicians and hospitals.
- Responsible for daily UM reviews – authorizations and denial reviews.
- Conduct peer to peer conversations for the clinical case reviews, as needed.
- Conduct provider telephonic review and discussion, schedule on-site visits, and share tools, information, and guidelines as they relate to cost-effective healthcare delivery and quality of care.
- Communicate effectively with network and non-network providers to ensure the successful administering of naviHealth’s services.
- Respond to clinical inquiries and serve as a non-promotional medical contact point for various healthcare providers.
- Represent naviHealth on appropriate external levels identifying, engaging and establishing/maintaining relationships with other thought leaders.
- Collaborate with Client Services Team to ensure a coordinated approach to delivery system providers.
- Contribute to the development of action plans and programs to implement strategic initiatives and tactics to address areas of concern and monitor progress toward goals.
- Interact, communicate, and collaborate with network and community physicians, hospital leaders and other vendors regarding care and services for enrollees.
- Provide leadership and guidance to maximize cost management through close coordination with all network and provider contracting.
- Regularly meet with naviHealth’s leadership to review care coordination issues, develop collaborative intervention plans, and share ideas about network management issues.
- Provide input on local needs for Analytics Team and Client Services Team to better enhance naviHealth’s products and services.
- Ensure appropriate management/resolution of local queries regarding patient case management either by responding directly or routing these inquiries to the appropriate SME.
- Participate on the Medical Advisory Board.
- Perform other duties and responsibilities as required, assigned, or requested.
- Graduate of a recognized medical school and recipient of an M.D. degree
- Must possess at least a current, unrestricted medical license and the ability to obtain licensure in multiple states
- At least 3 years of experience practicing in an acute inpatient environment, where dealing with managed care organizations made up at least half of inpatient practice
- Understanding of population-based medicine with preference given to significant experience with the Medicare population
- Strong business acumen, including working knowledge of changing U.S. payer and provider landscape
- Excellent organizational, verbal and written communication and presentation skills
- Ability to work with others while completing multiple tasks simultaneously and successfully
- Ability to complete assignments with reasonable oversight, direction, and supervision
- Highly motivated, flexible and adaptable to working in a fast-paced, dynamic environment
- Strong interpersonal skills and necessary business acumen to communicate and build positive relationships with management
- Clear, concise and persuasive verbal and written communication.
- Must be able to positively interact with other clinicians, senior management, patients and their families, and all levels of medical and non-medical professionals
- Excellent analytic skills
- Highest level of ethics and integrity
- Proficiency with MS Office Suite
naviHealth is improving the healthcare experience for seniors to live more fulfilling lives. For nearly a decade, naviHealth has been a trusted partner for the nation’s top health plans, health systems, and at-risk physician groups navigating the shift from volume to value. Powered by a predictive technology and decision support platform that provides clinicians and care teams with evidence-based protocols, naviHealth’s high-touch, proven care model fully supports patients from pre-acute through to the home. With naviHealth, patients can enjoy more days at home, and healthcare providers and health plans can significantly reduce costs specific to unnecessary care and readmissions. For more information about naviHealth, visit www.navihealth.com.