Senior Medical Director

Pinnacol Assurance does just one thing, and does it better than anyone: provide caring workers’ compensation protection to Colorado employers and employees. And while we may be a little biased, we believe that our work shapes communities and changes lives.

We have big hearts and love big ideas. We’ve been around for more than  100 years, but don’t let that fool you. Pinnacol is committed to taking care of Colorado employers and workers in the most innovative ways. We celebrate continuous improvement, new ideas, compassion, teamwork, integrity and excellence.

What you’ll do:

The Senior Medical Director works collaboratively with Operations Leadership to develop and maintain quality and medical management strategies and network programs. Will be responsible for implementation and evaluation of clinical programs, including but not limited to, value-based programs and incentives, care outcomes, central utilization review and program integrity.

What you can expect:

Acumen in strategic and operational planning to develop and implement innovative clinical initiatives and programs that optimize injured workers’ quality of care, outcomes, experience; and policyholder cost efficacy and value.

• Leverages data-driven insights to plan and execute clinical strategies targeting improvement that are consistent with best practices in workers compensation management, state and federal regulations.
• Provide meaningful strategic input to senior management, clinical staff, Physician Advisors, regulators and network providers concerning changes in accreditation standards, implications of proposed legislature, utilization management criteria, clinical guidelines, delivery system trends and related issues.
• Stays current with and develops strategies to implement leading-edge health technology and informatics. Leverages lean management principles to foster an environment of continuous learning, improvement, innovation and experimentation.
• Will be responsible for implementation and evaluation of clinical programs, including but not limited to, value-based programs and incentives, care outcomes, utilization management and program integrity.

In conjunction with the AVP and Director of Medical Operations, responsible for the development, maintenance and evaluation of provider network quality and outcomes. Identify opportunities for continuous improvement in the performance of the network and develop processes to monitor improvement.

• Assumes leadership responsibilities and actively participates as Chair of both the Credentialing and Quality of Service Committee (CQSC) and the Network Affiliation Committee (NAC) to develop and ensure network quality and consistency according to established standards.
• Responsible for the planning, directing and monitoring of the Physician Advisor program including training, performance evaluation, management oversight, sharing of best practices and supervision.
• Examines, analyzes and reports on network and non-network data trends and outcomes. Recommends and implements initiatives that address quality, cost, outcomes, experience and operations issues.
• Provides clinical expertise and direction that supports appropriate utilization management, and application of evidence-based practices.
• Actively supports and communicates network policies and procedures to providers and other medical organizations and works to ensure effective implementation and compliance of policies and procedures.
• Develops and improves provider relations across Colorado communities and actively participates in outreach efforts to expand the network and improve access to quality care for injured workers and policyholders.

Develops and maintains strong provider, business and community relationships. Works collaboratively across the organization building strong relationships and influence to improve operational performance and improvement.

• Actively engages with physicians to problem-solve, educate, coach and otherwise ensure quality and cost effective outcomes. Collaborates with physicians and provider groups on targeted issues.
• Able to build credibility and establish trust within all levels of the organization, providers, agencies, and policyholders.
• Listens, interprets, negotiates and consensus builds to successfully resolve issues and build support across diverse stakeholder groups.
• Bridges claims and medical management operations to network and providers on complex issues identifying and resolving pain points, and identifying opportunities for continuous improvement
• Consults, engages and serves as a resource to claims and medical management operations, safety and worksite wellness disciplines.
• Serves as a liaison on behalf of Pinnacol to legislative,