REMOTE - Vice President Medical Director of Clinical Programs

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond.  As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community.  Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day.  Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.
 

Position Summary
 

The VP Medical Director of Clinical Programs will manage the Health Plan Medical Directors and, as a Medical Director team, provide clinical support for the Health Management Utilization Management, Care Management and Quality teams. This VP will drive the development, promotion and delivery of high quality, evidence-based utilization and care management programs and processes.  The VP will lead programs and reviews to support effective medical expense management, medical quality programs and outcomes, and programs to manage medical utilization trends such as inpatient, Emergency Department, Site of Care, pharmacy and radiology

Job Description

Key Outcomes:

• Achieves defined clinical outcomes, affordability goals and growth targets, in partnership with HP SLT, to accomplish HP strategy, quality and cost containment
• Works closely across the HP to ensure compliance with government program regulations, including management of clinical appeals and grievances with sound clinical evidence and advice
• Works closely with the Medical Directors and the Director of Medical Economics to devise analytic approaches that support and measure strategic development and sound clinical programs
• Provides clinical insight into data to assist in development of and measurement of tailored interventions that address clinical trends and opportunities
• Develops key strategies to address opportunities in medical expense management
• Identifies opportunities for improvement in the quality of care that create competitive advantage for Martin’s Point as it relates to the health of populations served
• Accountable for appropriate Utilization Management processes including sound partnership and collaboration between the UM/CM team and the Medical Directors to ensure High performance of team members that drive the right services at the right place and time for our health plan members
• Assists and provides clinical input into the evolution of care/utilization management, quality, and pharmacy related programs
• Contributes to and advises in product design and the Medicare bid processes
• Contributes to and advises in areas of clinical integration as it relates to risk adjustment
• Serves as a central HP leader aligning medical, clinical, and operational functions to achieve seamless and thorough solutions related to Medical and Payment Policies
• Actively engages with quality, network, and compliance teams to help drive performance
• In collaboration with the MPHC Chief Medical Officer (CMO), advocates with government/state regulatory entities, professional and medical society chapters, federal regulators/contactors, and as part of external communications and media relations to advance HP’s clinical value story, evidence-based medical policies, and member health
• Provides subject/specialty-based clinical expertise and leadership to Clinical Programs and other areas of MHPC, as needed
• Assists the Market Medical Director for building and deepening relationships with area hospitals, physicians, and other health care providers in support of the Quadruple Aim
• Assists in creating a cohesive, network engagement strategy and reporting capability that supports iterative improvements in performance to population health and care management goals that are specific