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Director, Regional Med I PACE

Location: Los Angeles
Posted on: September 17, 2020

Job Description:

The Regional Medical Director (I) for PACE is responsible for the collaboration, integration and coordination of AltaMed PACE healthcare delivery systems at the sites over which he/she presides, to ensure maximum benefits to eligible PACE participants. Additionally this position shall be responsible to oversee all clinical aspects of utilization management, case management, chronic disease case management and all other areas necessary to facilitate the appropriate use of resources for senior patients and participants. The Regional Medical Director I - PACE also provides general guidance to comply with and set policies for reporting to lead to high quality and appropriate measurement of good clinical outcomes. The PACE Regional Medical Director (I) must be conversant with areas of geriatric, internal medicine and palliative care, show ability for rapid, accurate decision-making, and enjoy care review and the investigation and resolution of complex issues. The Regional Medical Director I - PACE must be a clear and compelling communicator with demonstrated ability to motivate, guide, influence and lead others including ability to translate detailed analysis and complex materials into compelling communications. The Regional Medical Director I - PACE may represent AltaMed in regulatory agencies, national associations, industry clinical leadership committees and appropriate forums.Managerial Skills: 10%In conjunction with the Medical Director of Senior Services, plans, organizes and directs AltaMed Health Services Corporation's PACE (medical/clinical) services, ensuring quality, culturally sensitive and cost effective care at PACE operations and programs at the sites he/she is assigned to.Oversight of 2-3 PACE sites for Site Medical Director, physician, Mid-level and Pharmacy staff, including hiring, performance appraisals, reward/recognition and leader development.Direct and orient physicians in the correct application of AltaMed approved guidelines.Responsible to ensure compliance in all areas of program operations and to prepare the necessary Corrective Action Plan (CAP) as needed in a timely process. (JCAHO; CMS; DHCS office of Long Term Care, Clinic; ADHC; Dept. of Education; Licensing and Certification; AltaMed)Oversee clinical operations of medical management and case management departments, including compliance with all regulatory issues related to utilization management inclusive of adequate documentation to support diagnosis and HCC reporting.Develop and maintain an effective relationship with all departments providing medical guidance and expertise.Establish and maintain good working relationships with AltaMed employed and contracted physicians and providers.Financial/Budgetary Skills: 20%Identify specialty services needs and collaborate in the contracting of providers.Provide strategic and operational direction for the delivery of performance based medical management.Coordinate financial budget and ongoing monitoring and performance improvements for areas focusing on clinical delivery systems in collaboration with Center Manager, Regional Administrator, Medical Director of Senior Services where applicable.Implements and coordinates program in accordance with regulatory requirements and established policy, program and budget requirements/parameters in coordination with Center Managers, Regional Administrators, and Regional Medical Director of Senior Services.Reviews expenditure reports and performance reports and makes recommendations on improvement of service delivery in collaboration with center managers, Regional Administrators, and Medical Director of Senior Services.Quality/Patient Care Responsibilities: 35%Review and final signature of delegated PACE site Incident Reports to monitor for quality of care issues, process improvement opportunities, and site training needs.Lead PACE Quality Management meetings where applicable at the delegation of Medical Director of Senior Services.Outlier high risk case review and guidance to IDT for opportunities for improved patient/quality outcomes.IDT/Care Planning, shadowing/oversight with routine guidance to IDT team members and group dynamics.Implement quality improvement programs as defined by corporate leadership.Maintain a customer-driven passion for excellence and commitment to innovation and implementation of ideas that improve the healthcare of the patient population.Identifies and support research studies to improve the medical practice for the frail populations.Develop systems, implement, and monitor the outcomes of utilization review and disease management programs to meet the quality and cost expectation of AltaMed.Daily review of referral/authorization requests rendering decisions based on national evidenced based guidelines to include approval of request based on PACE authorization matrix, process preliminary denials to be reviewed by Medical Director of Senior Services.Daily oversight and clinical lead for Inpatient team rounds with facility and staff partners in locations of delegated PACE sites for both Hospital and biweekly SNF facilities rounds.Monitor and update PACE UM network list for individual PACE sites delegated to oversee based on criteria of Quality/Utilization, Training/Credentialing, Access, Patient experience, Medical records, location.Actively monitor and evaluate performance of the hospitalist/SNFist program in areas covered by delegated PACE sites.General Responsibilities: 35%Perform clinical duties, as necessary, including float coverage for full scheduled days as appropriate to cover provider panels and clinical needs.Work seamlessly and effectively with both clinical and non-clinical departments within the organization and provide medical guidance and expertise.Play an active role in the AltaMed UM Regions and local medical community.Ensure participation on industry committees that require medical expertise.Responsible to remain abreast of Legislative and Contractual changes, State, Federal, and other regulatory agency standards.Licensed physician with a minimum of 4 years of clinical experience.A minimum of 2 years of leadership experience, preferably within medical management working in a managed care environment.Experience in working with Medi-Cal, Medicare and frail elderly or senior populations and knowledge of appropriate diagnostic reporting and HCC coding.

Keywords: ALTAMED HEALTH SERVICES CORPORATION, Los Angeles , Director, Regional Med I PACE, Executive , Los Angeles, California

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