Medical Director - Sharp Health Plan - Hybrid​/Remote - Day Shift

Hours

Shift Start Time:
Variable

Shift End Time:
Variable

AWS Hours Requirement: 8/40 - 8 Hour Shift

Weekend Requirements:
As Needed

On-Call

Required:

Yes

Hourly Pay Range (Minimum - Midpoint - Maximum): $124.640 - $160.830 - $197.020

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.

Working with the Chief Medical Officer, oversees medical care for Sharp Health Plan (SHP) products and services and oversees the health care needs of the membership. Serves as a medical manager and policy advisor to SHP and its Chief Medical Officer. Is accountable for and provides professional leadership and direction to the utilization/cost management and clinical quality management functions. Works collaboratively with other plan functions that interface with medical management such as provider relations, member services, benefits and claims management, etc.

Assists (as determined by the plan Chief Medical Officer) in short and long range program planning, total quality management (quality improvement), and external relationships. Works with all departments of Health Services to support, provide assistance and direction in overall medical management effectiveness. Reports all issues of clinical quality management to the health plan Chief Medical Officer. To ensure that policies and systems are followed until agreed upon change is implemented.

Works toward SHP strategic goals and objectives of ensuring a high quality of medical care for Plan members, staff empowerment, customer satisfaction, cost-effectiveness, and market competitiveness. As a member of the management team, assists in identifying and establishing strategic goals and objectives for the Plan.

• Doctor of Medicine (MD)
• Previous experience in the clinical practice of medicine.
• Previous experience as a physician executive in a managed care environment, preferably as an HMO Medical Director.
• California Physicians and Surgeons License - Medical Board of CA
  -REQUIRED

• Board certified in a medical discipline (internal medicine or family practice preferred).

• 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.
• 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.
• Implements health plan medical policies, goals and objectives.
• Provides professional leadership and direction to the functions within the Medical Management Department (Utilization/Cost Management and Quality Management)
• 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 Manager Medical Management and Quality Improvement Manager.
• Assists the Chief Medical Officer with activities to promote positive community relations.
• Assures plan conformance with legal and regulatory requirements
• Assists the Chief Medical Officer and the Quality Improvement Manager in creating and maintaining a system that gives feedback to providers individually and collectively regarding managed care effectiveness of individual providers and networks.
• Assists the Chief Medical Officer in designing and implementing corrective action plans to address issues and improve plan and network managed care performance.
• Collaborates with Chief Medical Officer in creating and maintaining programs that incentivize providers to achieve selected utilization/cost and…