Medical director - Network Support

Job ID: J120739
Company: Gateway Health Plan
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Sep 4, 2018

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Description

JOB SUMMARY

This job reports to the Chief Medical Officer, and is primarily responsible for educating and assisting network providers with implementation of value-based payment contracts offered by Gateway Health. Works in tandem with clinical operations, provider relations, finance and other area, the incumbent develops and delivers provider-specific health management strategies that align with and promote the organization’s clinical capabilities across the care management continuum. Presents customized clinical direction to providers, based on their specific risk profile, and facilitates interventions that optimize the health status of Gateway Health’s members with significant clinical and financial results. The incumbent facilitates other projects to strengthen the clinical expertise of Gateway Health.

ESSENTIAL RESPONSIBILITIES

  • Provide and interpret provider-specific clinical data to facilitate optimal interventions and significant clinical and financial results.  Analyze clinical data to help providers use such data to take action.
  • Engage providers with analyses and recommendations that address the present and future health status of their enrolled members, including high cost claimants and dependents.  Contribute to the development of new reports that simplify complex data sets.  Provide Clients with recommendations that will impact medical cost trends.
  • Provide effective presentations to providers and others on the Organizations clinical capabilities across the care management continuum.  Communicate Gateway Health’s clinical value proposition, based on clinical capabilities, provider data, clinical value of products, pay for value care strategies, and population health analytics.  Work with provider-relations and clinical operations staff to develop provider-specific health management strategies, i.e., action plans that address provider-specific clinical and financial risk, and justify investments in behavior change interventions.
  • Develop, maintain, and document strong working relationships with providers, consultants and other stakeholders in order to provide dedicated support and add value to the account relationship through clinical analysis, education, and presence.  Proactively maintain strong provider relationships through regular outreach through the year.
  • Work collaboratively with various internal and external leaders to ensure that a provider’s specific clinical data will drive the right interventions for the right members. This is accomplished through the use of population health analytics reports, and input from other Gateway Health departments and consultants.
  • Provide expert support, as needed, to various internal entities through project facilitation, conducting meetings, attending prep meetings, and other contributions of clinical expertise.  Demonstrate support for the innovation and change needed to improve effectiveness.  Understand the current regional and national health care environment and Gateway’s position on health care issues.  Understand and apply privacy regulations. This position requires business savvy, flexibility, tact, and the ability to build internal and external relationships.
  • Other duties as assigned or requested.

EDUCATION

Required

  • Medical Degree (MD or DO)

Substitutions

  • None

Preferred

  • Master's Degree in Business Administration/Management or related discipline

EXPERIENCE

Required

  • 5 - 7 years in the Healthcare Industry
  • 5 - 7 years in Clinical Service

Preferred

  • 10 - 15 years in Clinical Practice
  • 5 - 7 years in Management
  • 1 - 3 years in the Health Insurance Industry
  • 1 - 3 years in Provider Services
  • 1 - 3 years in Communications
  • 1 - 3 years in Client Management
  • 1 - 3 years in Value-Based Payment Programs

LICENSES AND CERTIFICATIONS

Required

  • Medical Doctor
  • Current, active and unrestricted PA Medical License
  • Current Board certification in ABMS specialty

Preferred

  • None

SKILLS

  • Analytical Skills
  • Clinical Software
  • Communication Skills
  • Coaching
  • Analysis of business problems/needs
  • Creative Problem Solving
  • Collaborative Problem Solving
  • Friendly Personality
  • Healthcare Industry
  • Negotiation
  • Provider Management
  • Health Education

Language (Other than English)

None 

Travel Required

25% - 50%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-Based

Teaches / trains others regularly

Frequently

Travel regularly from the office to various work sites or from site-to-site

Frequently

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Frequently

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Never

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

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