Medical Director (PACE, Quality & Population Health)

Medical Director (PACE, Quality & Population Health)

Job Description

Department: Medical Management
Reports to: Chief Medical Officer and Program Director, PACE
FLSA status: Exempt
Salary Grade: V – $221,400 – $331,200

Job Summary

The PACE Medical Director is responsible for the management and oversight of the physicians, nurse practitioners, pharmacists, and other staff assigned to his/her team. The PACE Medical Director oversees the clinical care provided by the CalOptima PACE program and ensures quality clinical service delivery to PACE participants. The PACE Medical Director is also responsible for overseeing clinical service contracts for the PACE program.

Position Responsibilities:

• Provides clinical leadership to the PACE program and participates in the development and implementation of the PACE program, including policies and procedures for clinical services and the quality assurance program initiatives (QAPI).
• Supervises clinical PACE staff, including physicians, physician extenders, and other members of the clinical team assigned to his/her supervision.
• Works jointly with the PACE Program Director to develop, implement, and update policies and procedures for the medical care of PACE participants.
• If needed, provides direct primary clinical care, including oversight of inpatient management and assessments and call coverage rotated with other physicians working in PACE.
• Serves as a liaison between the program and the physician/provider community, including participation in regional or national geriatric societies.
• Reviews all appeals and grievances.
• Coordinates quality assurance activities including the development, implementation, and ongoing evaluation of a quality assurance plan for the program.
• Provides information and conducts presentations regarding the PACE program as required.
• Participates in the Quality Assurance Committee, Ethics Committee, and other work groups, as assigned.
• Other projects and duties as assigned.

Knowledge & Abilities:

• Effectively interact with a wide range of health care and social services staff, working together as an interdisciplinary team.
• Work with the PACE Program Director in evaluating staffing needs as census changes.
• Evaluate and assist in establishing contracts for a wide range of clinical services, including hospital, pharmacy, specialists and nursing homes.
• Oversee the utilization of inpatient, pharmaceutical, specialty, and institutional long-term care services.
• Geriatric medicine; special needs of complex geriatric patients.
• Knowledge of industry and professional standards of health care, utilization management, quality improvement and other medical management functions.
• Knowledge of culture and needs of the socially and ethnically diverse population CalOptima serves.
• Knowledge of principles and practices of medical administration.
• Communicate clearly and concisely, both verbally and in writing.
• Utilize computer and appropriate software (e.g. Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Experience & Education:

• Valid MD license, in good standing, to practice medicine in the State of California required.
• Graduate of an accredited School of Medicine required.
• Minimum five years supervisory and administrative experience required.
• Minimum five years clinical experience required.
• Minimum three years experience working with elderly population required.

Preferred Qualifications:

• Board certified Geriatrician strongly preferred.

CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.

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Job Location: Orange, California

Position Type:

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