NextLevel Health Partners (NLHP) is a Medicaid managed health plan for people with Medicaid, but not Medicare, who live in Cook County. Our offices are located in communities we serve so we can better manage and coordinate the needs of our members’ one-on-one, right in their neighborhoods. We are a fast growing organization, seeking talented and driven employees to join our commitment to creating healthier communities.
Under the direction of the Chief Medical Officer, the Medical Director is the lead clinician actively involved in all major clinical program components of NLHP’s plan, including review of medical care provided, medical professional aspects of Provider contracts, and other areas of responsibility as assigned. The Medical Director shall devote sufficient time to NLHP’s plan to ensure timely medical decisions, including after-hours consultation as needed.
ESSENTIAL POSITION RESPONSIBILITES
- Working from a solutions-oriented approach, monitors clinical performance to ensure medical services and operations complies with all applicable regulatory and licensing agencies.
- Responsible for assisting in the development, implementation and review of clinical protocols, performance objectives, productivity benchmarks, compliance measures, provider workflow planning and provider scheduling.
- Serves as coach/mentor/trainer to staff providers, giving guidance in best practices, troubleshooting of medical services and operations issues in priority of urgency according to NextLevel Health policy and standards.
- Examines clinical programs information to identify members for specific case management and/or disease management activities or interventions by utilizing established screening criteria.
- Conduct admission review, post-discharge and discharge planning with clinical staff peers.
- Participates in internal meetings and represent the organization at required meetings with affiliated agencies, as needed.
- Participates as key member of organization’s Management Team (MT) to develop and maintain a strategic plan for the controlled growth, expansion, and/or development of programs and sites for NLHP;
- Solve existing and anticipated organizational problems; and formulate and/or revise policies that will enhance the achievement of the organization’s goals. Attends all Senior Management Team meetings with the overriding and ongoing goal of integrating clinical and non-clinical aspects of NLHP’s operations and services.
- Responsible for directing all providers in the practice of quality care according to standards and benchmarks set by the organization, licensing boards and funding agencies, via peer-to-peer discussions.
- Provide the planning and leadership to the Utilization Management department by ensuring that appropriate structures, systems, competencies and values are developed.
- Ensure that the interfaces between Utilization Management, Clinical Operations and other departments are managed optimally.
- Perform other related duties and/or projects as assigned,
- Oral and Written Communication Skills
- Attention to Detail
- Analytical Skills
- Board-certified Illinois-licensed Physician with a minimum of five (5) years of experience practicing in internal medicine, primary care, or pediatrics.
- Excellent communication skills with at least 5 years of established clinical experience
- Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products
- Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, utilization management, discharge planning and/or home health or rehab.