Regional Medical Director Massachusetts

Job Summary

The Regional Medical Director serves as the clinical leader within the geographic region, driving clinical outcomes, affordability, decreased total cost of care, the delivery of value-based care, and population health management across the care centers. This role encompasses leading transitional care teams, establishing relationships and communication pathways with hospital leaders and health systems, cultivating a sub-specialty network, and overseeing multidisciplinary teams of healthcare providers to ensure integrated and comprehensive patient care within the region.

Oversight of clinical, utilization management, and financial total cost of care outcomes for total members attributed to Absolute Care, whether we are the members’ primary care provider. Facilitating and leading discussions with providers regarding appropriate care, utilization, and care coordination. This includes inpatient, emergency departments, skilled nursing facilities, specialists, other primary care providers, home nursing and other providers within the healthcare ecosystem.

Special attention to reduction of Admissions/1000, Readmissions/1000, ED Visits/1000, and SNF days/1000

• Clinical Leadership and Oversight:
  Oversee clinical operations across multiple Care Centers within the assigned region. Serve as the clinical leader for a team, including physicians, Advanced Practice Providers (APPs), and behavioral health consultants, focusing on integrated and holistic approaches to reduce unnecessary utilization and improve patient outcomes. Responsible for clinical oversight across the geographic region, care coordination, and outcomes for all members attributed to Absolute Care;
  
  primary care and community-based members (non-PCP).
• Direct Care Delivery:
  Provide direct clinical care ~10-30% of the physician leaders time, in the form of caring for a small panel of the market’s highest utilizers, covering for full time providers as needed, and providing care in our immediate care area (same day, walk in, acute care, and hospital follow up for community members).
• Community based non-PCP member oversight and care coordination: understanding and appropriately influencing care occurring outside of Absolute Care’s centers. Individual members and at the population level.
• Transitional Care Management:
  Lead the development and implementation of effective transitional care plans across the region for all members attributed to Absolute Care (PCP or not) to ensure seamless patient transitions across different care settings. Accompany, train and mentor Transitional and Complex Care Managers in hospitals, Skilled Nursing Facilities and homes. This includes spending valuable time rounding in hospitals, skilled nursing, or other facilities – engaging members, building strong relationships and discussing cases with hospital/facility teams to drive the goals of transitional care:
  • Member engagement
  • Appropriate length of stay
  • Readmission reduction
• Network and Relationship Building:
  Represent Absolute Care in regional healthcare forums and community meetingss. Develop and maintain relationships with hospital leaders, health systems, community-based providers, and health plan care and utilization management teams to enhance coordination, clinical outcomes, appropriate utilization, and quality of care.
• Sub-Specialty Network Development:
  Spearhead the cultivation of a sub-specialty network that supports in integrated, high value specialized care for patients including home health.
• Quality Metrics and Patient Safety:
  Focus on achieving superior performance in HEDIS quality metrics, clinical coding documentation excellence, patient safety, engagement, and satisfaction.
• Strategic Initiatives:
  Develop and implement…