The Practicing Medical Director is responsible for medical oversight of the Medical Management Program Description of P3 Health Partners regarding medical necessity decisions, utilization review, inclusive of prior authorization, concurrent and retrospective review, discharge planning and transitions of care to the appropriate level. The Medical Director supports achieving the Quadruple Aim: improved outcomes, improved patient experience, improved clinician experience, and decreased cost of care. The Practicing Medical Director will spend 50% of their time seeing patients.
Education and Experience: Current, unrestricted, Nevada medical license (MD or DO)Training or Interest in Geriatrics welcome but not requiredCurrent DEA licenseAdvanced degree such as MBA, MHA, MPH or MMM preferredBoard certified and primary care preferredBoard Eligible or Board Certified in Family or Internal MedicineAppropriate unrestricted state medical licensesMinimum 5 years practice experienceMinimum 2 years as a lead physicianExperience in managing Medicare Advantage (MA) populations in global risk arrangements preferredKnowledge of utilization management to include experience applying medical management treatment guidelines and nationally recognized criteria, such as CMS NCD/LCD, InterQual / McKesson, MCG, or other practical management guidelines requiredKnowledge, Skills and Abilities: Strong problem-solving skills requiredExcellent at both physician and patient engagement strategiesExperience in a managed care organization preferredKnowledge of medical terminology requiredExcellent communication skills with patients, providers, internal and external customers requiredMust have excellent organizational skills, attention to detail, and ability to work independentlyEssential Functions: Promote the mission, vision and values of P3 Health PartnersResponsible for medical necessity decisions and peer to peer communicationsPlans and directs medical policiesResponsible for strategic clinical relationships with physicians, identifying clinical trends, and directing data analysisResponsible for quality and continuous improvementResponsible for all actions/responsibilities as described in P3 controlled documentation for this positionContributes to and supports P3 quality initiativesLeads and contributes to Quality Committee GovernanceAssist in developing in Utilization Management and Quality Management programsDevelops policies and procedures, guidelines, and training to ensure compliance with federal, state, NCQA, health plan, and internal regulationsResearches, identifies, and implements new technologies that contribute toward increased qualityLeadership through designated monthly meetingsOther duties as assignedCompensation: Top of the market guaranteed Compensation with bonus structure, sign on, relocation if needed, and full benefit package.Quality of care focus, spend quality time with your patients, partners, and each other.QualificationsEducationPreferredMasters or better.
Licenses & CertificationsRequiredDO License
MD License
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
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