Dignity Health Regional Medical Director in Scotts Valley, California
The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.
Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.
The Regional Medical Director is responsible for providing clinical expertise and business direction in support of medical management programs which promote the delivery of high quality medical care. Provides technical expertise in medical management by direct involvement in inpatient and out-patient authorization, appeals and grievances. Takes an active role in designing and implementing quality improvement programs for the region and representing the region in corporate committees. This position is responsible for all UM activities including, but not limited to adherence to clinical guidelines, measuring adherence to guidelines, and communicating utilization and quality concerns on specific cases to the provider network.
Graduation from an accredited medical school with a degree of M.D. or D.O.
Completion of approved residency. Board Certification is preferred.
Current unrestricted license to practice medicine within the State of California.
Five years’ experience practicing medicine in a managed care environment. Two years’ experience in medical management, preferably with an IPA.
Valid California driver’s license required.
Knowledge of current laws and regulations governing HMOs, capitation, and risk-based
physician and hospital payment methodologies.
Knowledge of Medi-Cal and Medicare programs.
Ability to identify healthcare needs of enrolled populations.
Working knowledge of NCQA and HEDIS measurement, indicators and methodologies preferred.
Experience in the use of measures of clinical effectiveness and outcomes, and their use in performance improvement.
Strong clinical skills and knowledge of concurrent review, case management, ambulatory utilization review.
Understanding of physician practice management and medical information systems is required.
Demonstrates a high degree of judgment, resourcefulness, diplomacy and organizational abilities.
Must be attentive to detail, accurate, thorough, and persistent in following through to completion of all activities.
Excellent communication skills; able to read, write, and speak articulately. Able to use established channels of communication and reporting relationships within the organization
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If you need a reasonable accommodation for any part of the employment process, please contact us by telephone at (415) 438-5575 and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this telephone number.
Job ID 2018-55942
Employment Type Full Time
Department Medical Staff Administration
Hours / Pay Period 80
Facility Dignity Health Management Services Organization
Location Scotts Valley
Standard Hours Mon-Fri (8-5 PM)
Work Schedule 8 Hour