This position partners with the business leaders in the Accountable Care Organization (ACO) and Health Maintenance Organization (HMO) areas to develop, implement and partner with other organizations for the creation of successful ventures for Children’s Health System of Texas (CHST). This will include interactions with third-party payers, other health systems, Health and Human Services, Texas Department of Insurance and major employers.
The interactions and initiatives will cross both the value-based contracting as well as the fee-for-service (traditional) areas of the hospital and health system.
Will provide medical leadership for the provider-based insurance and managed care functions and, in so doing, serve as the primary medical interface with external third-party payors, government agencies, hospital, third-party administrators, brokers and employers.
Will be a clinical change agent and champion for change with the Children’s and UTSW pediatric clinical environments, as well as in the external environment.
• Typically provides leadership through multiple layers of subordinate managers
• Accountable for the financial and operational performance of a function or multiple related functions
• Communicates a compelling vision for the future of the function in the context of Children’s strategies and mission
• Develops strategies for the function that are aligned with Children’s mission and strategy; provides input as needed, to strategy and long-term planning of Children’s
• Establishes metrics within the function and oversees execution of strategies to achieve key organizational objectives
• Makes decisions regarding budget allocation within own area of responsibility and influences the allocation of resources across multiple functions
• Is accountable for decisions that have significant impact on financial or operational performance of more than one function
• Serves as a change champion for key organizational initiatives, including initiatives that are outside their own area of responsibility
• Accountable to the Board of Directors
Essential Duties and Responsibilities
• The Medical Director will provide physician leadership for discussions, continuing education initiatives, demonstration projects for managed care utilization, care, and disease management and quality. Additionally provide medical leadership for the medical management of CMCHP members.
• In partnership with key leaders, facilitate and participate in negotiating population-based contracts with employers, government contractors, payors and accountable care organizations. The Medical Director will simultaneously serve as the primary physician resource for providers in negotiation/education of risk arrangements and new strategic alliances.
• In conjunction with the executive leadership of Children’s Medical Center, UTSW Division Directors, the Chief Clinical Officer and the VP, Clinical Integrated Networks, the Medical Director will support the development and implementation of an integrated care delivery system across community-based provider settings, UTSW specialty and subspecialty settings, and Children’s Medical Center settings.
• The Medical Director will provide physician leadership for discussions, continuing education initiatives, demonstration projects and new ventures with third-party payors and employers. As an example, provide medical leadership for innovative health improvement initiatives for employer groups. Additionally provide medical leadership for the medical home and pay-for-performance demonstration projects with third-party payors.
• In conjunction with the leadership of Children’s and UTSW, build formal alliances and ventures with integrated health care systems, adult hospitals and adult accountable care organizations, positioning Children’s as the preferred pediatric referral destination of choice for children with complex illnesses.
• Build positive, productive personal and professional relationships with external affiliates and UTSW physician leaders.