Medical Director CFHP – Quality Improvement

ORGANIZATIONAL COMMITMENT

A strong commitment to service excellence, positive clinical outcomes, cost efficiency, performance enhancement and high business ethics is required.  Comprehensive knowledge in the area of specialty with a result oriented and patient-centered focus.  Supports the strategic vision of the organization.  A personal commitment to treat all customers with courtesy, dignity, respect and professionalism and adherence to the Community First Health Plans Commitment to Service Excellence behaviors and standards.

 POSITION SUMMARY

The Medical Director of Quality Improvement, Community First Health Plans (Community First), will serve as a visible physician leader whose task is to champion quality & safety, customer satisfaction, efficiency and access.  The Medical Director will partner with senior leadership across the organization and throughout the organization’s service region to continue to strengthen and grow data driven, member centric, population-based quality management strategies, integrating physical, behavioral, social and cultural determinants of health designed to produce positive health outcomes. Management responsibilities include consulting with and advising senior members of the organization on matters regarding provider practice patterns, utilization of resources, medical necessity, compliance rules and regulations, collaboration and relationships with payers and the community, and clinical documentation improvement. The Medical Director of Quality Improvement will build robust relationships with community partners and engage strategically with participating providers in the network sharing quality data and implementing initiatives with shared goals of improving member’s health. Promotes and supports environment of continuous quality improvement in all aspects of service to its members, providers, staff, and community.

EDUCATION/EXPERIENCE

Medical degree as Doctor of Medicine or Osteopathy and an active and unrestricted Texas Medical License, free of sanctions from Medicaid or Medicare is required. Board certification from the American Board of Medical Specialties is required (primary care specialty is preferred). Master’s degree with formal education in ambulatory-based medical management, public health, or business administration is preferred. A minimum of five years of clinical experience and three years managed care experience is preferred. Previous HMO or PPO leadership position experience is preferred with knowledge and understanding of components of population health management to include utilization review and quality management.

LICENSURE/CREDENTIALING

Must possess current active and unrestricted license to practice medicine in the State of Texas. Maintain Board certification from the American Board of Medical Specialties.  Must follow rules/regulations as set forth by the Texas Medical Board Medical Practice Act.

EQUIPMENT

Knowledge and familiarity with standard office equipment. Knowledge of basic computer applications. Proficient in Microsoft Office software, healthcare analytics database analysis, and reporting products. Develops and maintains working knowledge of and/or utilizes data from the host financial and clinical systems.

WORKING CONDITIONS

Work is subject to frequent interruptions, deadlines and decisions.  May encounter various hazards usual to health system operations.  Local travel to Network Provider offices and other Health System facilities is required. Occasional out of town travel may be required. Hours of duty may be long and irregular. Some on call duty may be required.  Evenings, weekends, and holidays may also be required.

OTHER

Possesses excellent interpersonal and organizational skills and can work effectively with a diversity of personalities. Maintain an operational soundness with the ability to grow programs and work with people collaboratively to achieve goals. Must use mature judgment and communicate effectively in dealing with the governing board, administrators, physicians, employees, members, and guests. Effective written and verbal communication skills, strong management and leadership skills, and able to develop and conduct formal presentations for a variety of internal and external stakeholders. A proven ability to work across organizational boundaries. Proficient in multi-tasking, problem-solving, prioritizing, analyzing, organizing and planning. Ability to respond effectively to sensitive inquiries or complaints. Knowledge of federal health care regulations and awareness of regulatory and enforcement agencies. Knowledge of performance improvement principles. Ability to effect good medical staff relations and work effectively with all healthcare disciplines. Skilled in negotiation and conflict resolution. Possesses project management, information management, and facilitation skills. Experience with statistical analysis programs, analytical charting and graphing software preferred. Must successfully complete the pre-employment/post job offer health screening examination and the annual screening, each year thereafter, as an employee.

Position Description »