Senior Medical Director

Job Description

Position Summary:

The Senior Medical Director works actively as part of the Regal Medical Leadership Team which includes Regal Medical Directors, VP Medical Management, and other clinical and quality leaders. The Medical Director is charged to work optimize clinical outcomes, ensure quality and timely care, render care in compliance with regulatory and other criteria, and expend care resources in an efficient and effective manner. This is expected to be done with professionalism, commitment to collaboration, expediency and urgency when indicated, and acute sense of team citizenship.

Essential Duties and Responsibilities include the following:

• Oversees and directs medical management activities to attain Regal quality and timeliness of care, utilization management, and related care goals
• Oversees and directs management of all Vital Care programs and operations (VC Clinics, Home Visiting Programs, Case Management, Social Services, Pharmacy, Palliative Care, Hospice, HCC).
• Directs and facilitates daily Vital Care Case Rounds.
• Participates as a clinical provider in VC Clinics.
• Oversees and works collaboratively with RMG South Regional Medical Director for South concurrent review operations.
• Oversees and directs management GCMG Concurrent Review team and medical directors.
• Oversees daily South UM meetings.
• Works collaboratively with Regal Prior Auth Medical Directors and staff on operational issues.
• Oversees and directs management of RMG North and South SNF program operations.
• Participate in scheduled on call duties for both Vital Care and Concurrent Review teams.
• Identifies and participates in the development and implementation of Concurrent Review and Vital Care Management policies and procedures and ensures compliance and consistency throughout Regal Medical Groups regional sites.
• Monitors and analyzes Concurrent Review/Vital Care Management reports and identifies trends and makes recommendations and develops programs and interventions to improve management.
• Implement disease and medical care management programs
• Actively enlist network physicians, provider, and facilities to optimize care and attain resource utilization goals
• Provide clinical management and administrative input to other Regal departments to optimize processes, staffing, policies and procedures and positively impact the delivery of medical care
• Train and mentor clinical and other staff to ensure their growth and development
• Lead operational assignments with an emphasis on execution, outcomes, continued improvement, and attaining performance goals.
• Conduct concurrent review, prior authorization review, case management, and other medical management activities as necessary; including scheduled night and weekend call for these activities.
• Interface with providers (physicians, groups, hospitals, health plans) to improve health care outcomes, health care service utilization and costs.
• Attend Joint Operating Committees (JOCs), vendor meetings, health plan meetings, and other like activities as necessary.
• Participate on quality improvement, utilization management, credentials, and other committees as assigned
• Support efforts to obtain and ensure continued accreditation with regulatory agencies.
• Represent Regal Medical Group to employer groups, physician groups, individual physicians, managed care organizations, and state medical associations and societies.
• Analyze clinical and financial data to develop and refine management activities, investigate and define sources of variation, and ensure conformance with standards and criteria.
• Support analysis of performance data of physicians and hospitals to identify variance to expected results, and develop and implement corrective action plans as needed.
• Perform other duties as assigned
• Maintain up to date medical knowledge base through personal studies and attendance of appropriate CME activities.

The pay range for this position at commencement of employment is expected to be between $200,000 - $300,000 annually; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, employee will be in an "at-will position" and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

Full Time Position Benefits:

The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

Health and Wellness:

• Employer-paid comprehensive medical, pharmacy, and dental for employees
• Vision insurance
• Zero co-payments for employed physician office visits
• Flexible Spending Account (FSA)
• Employer-Paid Life Insurance
• Employee Assistance Program (EAP)
• Behavioral Health Services

Savings and Retirement:

• 401k Retirement Savings Plan
• Income Protection Insurance

Other Benefits:

• Vacation Time
• Company celebrations
• Employee Assistance Program
• Employee Referral Bonus
• Tuition Reimbursement
• License Renewal CEU Cost Reimbursement Program
• Business-casual working environment
• Sick days
• Paid holidays
• Mileage

Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

Requirements

Requirements:

• Graduate of an accredited medical school with MD or DO degree
• Completion of accredited residency training program