Senior Medical Director

The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California and future increases will be based on the pay band for the city and state you reside in.

Work Culture:

GCHP strives to create an inclusive, highly collaborative work culture where our people are empowered to grow and thrive.  This philosophy enables us to create the health plan of the future and do our best work – Together.

GCHP promotes a flexible work environment. Employees may work from a home location or in the GCHP office for all or part of their regular workweek (see disclaimer).

GCHP’s focuses on 5 Core Values in the workplace:

•    Integrity

•    Accountability

•    Collaboration

•    Trust 

•    Respect

Disclaimers:

•    Flexible work schedule is based on job duties, department, organization, or business need.

•    Gold Coast Health Plan will not sponsor applicants for work visas.

POSITION SUMMARY

The Senior Medical Director (SMD) is a key leadership position within Gold Coast Health Plan’s Health Services Department. The SMD role will work in close coordination with the Chief Medical Officer (CMO), supporting key functions under the Office of the CMO, which includes Quality Improvement (QI), Clinical Quality Improvement, Pharmacy, Care Management Health Equity, and Utilization Management (UM) Departments. Role works to assist the CMO in the successful execution of planning and operational responsibilities. The SMD will provide direct guidance/consultation/training of Utilization Management, Care Management, Quality Improvement, Clinical Quality Improvement, and Pharmacy Departments while also assisting other GCHP Department with other critical functions as assigned by the CMO.  

ESSENTIAL FUNCTIONS

Reasonable Accommodations Statement

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

Essential Functions Statements

Duties and Responsibilities

•    Provides guidance, consultation, and training to Utilization Management Department staff in collaboration with the Health Services Executive Director

•    Provides guidance, consultation, and training to Pharmacy Department staff in collaboration with the Director of Pharmacy. 

•    Provides direct support and guidance to Credentialing staff

•    Provide direct support, guidance, and training to Grievance and Appeals staff in collaboration with Operations and/or the Grievance and Appeal RN Senior Manager 

•    Provides direct support and guidance to the RN Senior Manager of Clinical Quality who oversees the Potential Quality Incident (PQI) team, and the Facility Site Review team

•    Provides clinical support, thought partnership to the CMO and direct reports for all areas of the Office of the CMO, including Health Services, Quality Improvement, Clinical Quality Improvement, Management, Health Equity, and Pharmacy departments

•    Ensures and helps maintain Office of the CMO department compliance and maintenance of CMS, DHCS, DMHC, NCQA, and other regulatory and certification agency standards

•    Attends or chairs, at the discretion of the CMO, committees such as Utilization Management, Credentialing, Medical Advisory, Quality Improvement and Pharmacy

•    Supports development of Interdisciplinary Care Team (ICT) model and participates in ICT rounds

•    Participates in health plan on-call physician rotation

•    Assumes CMO responsibilities when CMO is unavailable due to scheduled vacation or unexpected absences

•    Oversees and supports GCHP contracted medical review physicians, and GCHP medical directors

•    Provides Office of the CMO department support and leadership

     o    Supports the Executive Director of Health Services

     o    Supervises and supports contracted GCHP medical review physicians

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