Territory Medical Director, Physician

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We are committed to building the best primary care environment for patients and are seeking healthcare enthusiasts to join us.


Job Summary

The Territory Medical Director reports to the Vice President of Practice Operations to directly oversees medical and clinical activities for Cano Health within their assigned territory.
Exercises professional judgment to oversee the performance/practice of medicine by our employed or contracted physicians and uses best efforts to ensure that such services are provided in a safe, competent, and efficient manner for our members.
Report any deficiencies or recommends changes to Vice President of Practice Operations.
May participate in state and local healthcare related meetings to acquire and apply knowledge of social, regulatory, political, and economic factors that relate to health services.
Also participates in population-based care management, public health efforts, and provides guidance in the appropriate utilization of healthcare resources.


Essential Duties & Responsibilities Ensure compliance with adverse incident reporting requirements.
Conduct systematic reviews of clinic billings to ensure that the billings are not fraudulent or unlawful.
Will conduct periodic chart review on providers in accordance with state regulations.
Renders decisions related to patient safety or medical quality in situations where written policies do not exist or are not clear.
Works to optimize utilization of Cano's services and resources and works to ensure adequate staffing levels for the clinical areas within the Group.
Must be available to facilitate member medical decisions and direction to providers regarding member emergent and emergency care.
Shall work to develop, maintain, organize, and implement the QIP, proper documentation, verification, and HEDIS audits according to Cano's protocols in a timely and efficient manner with adequate resources.
Results are to be reported and reviewed with relevant parties prior to distribution.
Will work with other assigned District administrative staff (District directors of Operations, Project Managers, Provider Support Specialists, etc.)
to review clinical team's performance, improve quality of care, CME completion by clinical staff, GSM meetings, Provider meeting attendance, as well as completion of EHR tasks (Jellybeans, Unlocked Notes, etc.).
Will participate and work with the District Medical Director team to review clinical team's performance, discuss interventions/policies and implement Cano Health protocols at Medical Directors meetings.
Shall review all adverse events and determine whether such events are reportable in accordance with applicable law.
Shall work with the executive leadership team as needed to develop protocols as required by law.
Will work as needed to evaluate all medical grievances from providers and coordinate solutions with the team.
Will work as needed for training and development of all PCPs regarding proper clinical documentation, coding accuracy, HEDIS, and software utilization.
Will conduct at least once a month meeting with District Medical Directors and Directors of Operations to review clinic issues that arise and go over existing or new polices as needed.
May in the absence of a Provider need to sign or co-signing pertinent docs (progress notes, death certificates, RX pads.)
May need to be billing supervisor for up to five medical clinics.
May be required to sign center level documents to include, but not limited to center permits or Air-gas permits.
Review with district physicians PCPs Scorecards/Utilization review to include but limited to: Utilization, HEDIS, ER/Admission, GDR, patient volume, KPI's defined by Senior Leadership etc.
Will meet with physicians within their district to complete performance reviews and bonus discussions and review.
Will meet monthly with Health Center Managers to review critical results including but not limited to: patients seen per day, NPS scores, provider schedules, etc.
Will provide physician leadership, guidance on clinical best practices, and provide provider mentorship.
Will be responsible for ensuring there is proper review and approval of CME time off, expense approvals, and PTO approvals over ten days.
Working with District Medical Directors and Directors of Operations in handling provider performance matters Will meeting with CDIS team to review provider performance and develop and implement strategies and education to improved documentation accuracy.
Will work to develop Clinical competency evaluations and education.
Will work to provide software optimization review, such as EMR and Navina, provide provider feedback, and review provider usage.
Will work to develop Utilization strategies and education.
Will assist in company acquisition due diligence.
Will review referral usage and work with Referral Department for developing efficient strategies in proper usage.
Will be responsible for interviewing provider candidates.
Will effectively evaluate business opportunities and areas of cost savings.
Will work independently and along with other departments to help with Member Growth Strategy and Retention.
Will work to develop effective provider Onboarding and be available for check ins and touchpoints.
Will assist with project-based requests and provide clinical advice to respective company departments, i.e., new workflows and strategies, Pop Health Dashboards, etc.
Will work with the Quality Director to help establish HEDIS strategies and overview.
Will effectively communicate to providers including but not limited to monthly provider meetings and emails.
Shall work to establish Provider Recognition Initiatives.
Will work to devise and implement Care Management best practices.
Shall work to develop strategies for caring for our most vulnerable and High-Risk members.
Shall work to coordinate high risk care with Cano@Home.
Additional Duties & Responsibilities Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the associate for this job.
Duties, responsibilities, and activities may change at any time with or without notice.
Supervisory Responsibilities The Territory Medical Director will oversee a group of medical directors and providers in a given Territory.
Territory Medical Directors will be responsible for the clinical care of their patients in the office and will be given 80-100% of FTE hours per week for administration duties.
Education & Experience Medical degree with National Board Certification in family medicine, internal medicine, or emergency medicine.
Current National Board Certification or eligible +5 years medical leadership/directorship experience MBA preferred.
+5 years Value Based Care experience Education Requirements Required/Preferred Education Level Discipline

Required

Undergraduate Degree

Knowledge, Skills & Proficiencies Skilled in operating phones, personal computers, software, and other IT systems.
Skilled in oral communication.
Ability to communicate with associates, patients, and other individuals in a professional and courteous manner.
Ability to pay close attention to detail and to ensure accuracy of reports and data.
Fluent in English and Spanish preferred Physical Requirements

This position works under usual office conditions.
The associate is required to work at a personal computer as well as be on the phone for extended periods of time.
Must be able to stand, sit, walk, and occasionally climb.
The incumbent must be able to work extended and flexible hours and weekends as needed.
Physical demands include the ability to lift up to 50 lbs.


The physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of the job.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


Work Conditions

Must be able to perform essential functions such as typing, standing, sitting, stooping, and occasionally climbing

Travel Requirements Travel Required Amount of Expected Travel Details

Yes

0-25%

Work will involve some driving/traveling to assigned clinics.


Tools & Equipment Used

Computer and peripherals, standard and customized software applications and tools, and usual office equipment.


Disclaimer

The duties and responsibilities described above are designed to indicate the general nature and level of work performed by associates within this classification.
It is not designed to contain, or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of associates assigned to this job.
This is not an all-inclusive job description; therefore, management has the right to assign or reassign schedules, duties, and responsibilities to this job at any time.
Cano Health is an equal opportunity/affirmative action employer.
All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.


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