Senior Medical Director - Sharp Health Plan - Hybrid / Remote - Day Shift - Full Time

Hours:

Shift Start Time:

8 AM

Shift End Time:

5 PM

AWS Hours Requirement:

8/40 - 8 Hour Shift

Additional Shift Information:

Weekend Requirements:

No Weekends

On-Call Required:

No

Hourly Pay Range (Minimum - Midpoint - Maximum):

$134.360 - $173.380 - $212.390

 

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position.  The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices. 

 

What You Will Do

This Senior Medical Director position provides critical management and oversight for Sharp Health Plan's (SHP) physicians (Medical Directors (both medical and behavioral health) and the Physician Reviewers) to coordinate the necessary co-management of our members related to their medical, behavioral health and pharmacy needs.

This position also provides the physician cohesive collaboration necessary for the continuum of care foundation for our NCQA required population health management program.

Additionally, this position provides the representation of physician's insight, perspective and leadership on the Health Services Management team and the other strategic and operational leadership, projects and meetings throughout the SHP.

This position oversees all physician management and medical care and for all of Sharp Health Plan products, (Commercial, Exchange, Medicare, POS/PPO) services, and oversees the health care needs of the membership. Serves as a lead medical manager and policy advisor to SHP clinical and its' Chief Medical Officer.

Required Qualifications

• Doctor of Medicine (MD) - Internal Medicine or Family Practice
• OR Doctor of Osteopathic Medicine (DO) - Internal Medicine or Family Practice.
• 15 or more years of clinical practice of medicine.
• 5 years' experience as an HMO Health Plan Medical Director.
• California Physicians and Surgeons License - Medical Board of CA -REQUIRED

Other Qualification Requirements

• Unrestricted license CA MD/DO license required.

Essential Functions

• Provides critical management and oversight for the Plan's physicians (Medical Directors (both medical and behavioral health) and the Physician Reviewers) to coordinate the necessary co-management of our members related to their medical, behavioral health and pharmacy needs.
• Responsible and accountable to the Chief Medical Officer for helping to manage health plan medical costs and assuring appropriate health care delivery for SHP's products and services. Reports organizationally to the Chief Medical Officer.
• Provides the representation of physician’s insight, perspective and leadership on the Health Services Management team and the other strategic and operational leadership, Projects and meetings throughout the Plan.
• Works collaboratively with other plan functions that interface with medical management such as provider relations, member services, benefits and claims management, IT management, etc.
• Plans, organizes, and directs the professional medical services program, consisting of all primary and specialty services for in-patient, out-patient, preventive and wellness programs.
• Develops and Implements health plan clinical policies, goals and objectives.
• Provides professional leadership and direction to the functions within the Medical Management Department (Utilization/Cost Management and Quality Management)
• Develops and updates Physician management department work plan.
• Responsible for and assists with the development of staffing plans and assuring the adequate allocation of resources to the medical management functions.
• Responsible and accountable for implementing the Utilization/Cost Management Program and Quality Improvement Program, in conjunction with the Director of PHM/ Medical Management and Quality Improvement Director.
• Oversees and mentors Medical Directors and Physician Reviewers.
• Actively engages with SHC leaders in Physician Experience Council, Physician Leadership Academy and other key physician leaders to promote quality of care in a timely, efficient, effective and equitable manner.
• Assists the Chief Medical Officer with activities to promote positive community relations.
• Assures plan conformance with legal and regulatory requirements.
• Assists CMO in continued builds strong partnerships with Medical Director PMGs and