Job Description

Position Title:Sr. Medical Director / Exempt _X__/ Non-Exempt___
Position Code:10001079 / Mgmt _X__ / Non-Mgmt ___
Reports To:VP & Sr. Medical Director of Health Services / Dept:Managed Care
A. Job Summary
The Senior Medical Director is a member of the AMS Division leadership team.
The role has responsibility for medical management activities and programs, including referrals and authorizations, inpatient review, ambulatory case management, and clinical quality initiatives. The Senior Medical Director interacts and consults with operations and senior management in the planning, implementation, and clinical oversight of care and utilization management programs. The role also is involved in the strategic planning and growth of the managed care business.

B. Major Job Duties and Responsibilities

Essential Functions Guide
(1)If unable to perform this function may have serious consequences.
(2)The performance of this function is the reason the job exists.
(3)There are limited employees among whom the performance of this function can be distributed.
(4)This function is highly specialized and employees are hired for the skill/ability to perform it.
  1. C-I-CARE (1, 2)
  1. Executesworld class practices of service and patient care in support of C-I-CARE standards.
  2. Uses C-I-CARE templates and the following components for all communication with patients and staff:
  • CONNECT with people by calling them their proper name, or the name they prefer (Mr., Ms., Dr.)
  • INTRODUCE yourself and your role
  • COMMUNICATE what you are going to do, how long it will take, and how it will impact the patient
  • ASK permission before entering a room, examining a patient or undertaking an activity
  • RESPOND to patient’s questions or requests promptly; anticipate patient needs
  • EXIT courteously with an explanation of what will come next

  1. Clinical Management
  1. Lead and develop the clinical efforts to provide “Great Affordable Healthcare” for our members
  2. Provide clinical oversight for all activities related to the authorization of eligible services.
  3. Oversee utilization management and medical management defined under regulations and contracts with HMO’s, federal, and state departments.
  4. Provide medical leadership for the management of in-patient activities/processes.
  5. Provide clinical guidance on activities related to the Quality Programs and Improvement initiatives.
  6. Provide medical support for the activities related to the Appeals and Grievances processes to ensure compliance with state, federal and company standards and regulations.

  1. Strategic Planning & Development
  1. Recommends potential growth opportunities for new or existing services within the market.
  2. Build relationships with key staff of the contracted health plans, key community and business partners, and work closely with peer senior management and medical directors to ensure integration of clinical operations strategies.
  3. Lead Accountable Care Committee physician meetings.

  1. All other duties as assigned including department-specific functions and responsibilities (1, 2):
  2. Performs other duties as assigned and participates in organization projects as assigned.
  1. Adheres to safety, P4P’s (if applicable), HIPAA and compliance policies.

C. INDEPENDENT JUDGMENT:

Work is performed in accordance with established schedules and procedures, but employees are expected to prioritizeassignments, adjust schedules or alter sequence of steps as necessary to obtain desired results.

  • Ability to identify problems and seek solutions using appropriate resources.
  • Identifies appropriate areas for professional growth and attends continuing education classes throughout the year.

D. ESSENTIAL SKILLS, BODIES OF KNOWLEDGE AND ABILITIES THAT ARE REQUIRED FOR THE POSITION. (for management positions, include leadership behaviors)

  1. High level of verbal and written communication skills with a strong capacity for detail, maintaining clear/effective contact with physicians, employees, administration and corporate personnel.
  2. Strong organizational and planning skills to manage multiple priorities and meet required deadlines.
  3. Strong analytical, critical thinking and problem solving skills to ensure process improvement and projects are completed successfully.
  4. Proficient computer skills to include Microsoft Office (Word, Excel, and PowerPoint).
  5. Strong interpersonal skills necessary in order develop and maintain collaborative relationships with staff and physicians.
  6. Commitment to top quality managed care
  7. Excellent communication effectiveness, inclusive of non-physicians, strong leadership.
  8. Ability to form and test theories, and utilize data and analytic approaches to solving difficult problems.
  9. Management skills necessary to attract and maintain a highly effective and motivated staff.
  10. Proven ability to work independently to produce accurate work of the highest quality.
  11. Demonstrated ability to access state and federal websites for coding, billing and reimbursement information.

E. EQUIPMENT OR MACHIINES THAT MUST BE OPERATED TO PERFORM THE JOB ACCEPTABLY.

F. WORKING CONDITIONS:

General office environment may require occasional weekend and/or evening work.

G. ENTRY LEVEL FORMAL EDUCATION, EXPERIENCE, VOCATIONAL TRAINING AND/OR CERTIFICATIONS AND LICENSES.

REQUIRED:

1. Graduate of an accredited school of medicine with a designation of MD or DO and Board Certification.

2. Active California medical license and good standing with the Medical Board of the State of California.

3. Minimum of seven or more years of clinical practice, participation in a leadership role in medical staff organization activities, and through management experience within a health care delivery system.

4. Three to five years of management.

5. Experience in managed care.

6. Experience with utilization management and quality management programs.

7. Demonstrated excellence with interpersonal communication skills.

8. Technology aptitude.

PREFERRED:

1.

2.

APPROVALS

EMPLOYEE DATE: ______

SUPERVISOR DATE: ______

DEPARTMENT MANAGERDATE: ______

HUMAN RESOURCES DATE: ______

THIS JOB DESCRIPTION IS INTENDED TO BE AN OVERVIEW OF THE REQUIREMENTS FOR THE STATED POSITION AND IS NOT TO BE CONSTRUED AS ALL INCLUSIVE OF THE DUTIES, RESPONSIBILITIES OR REQUIREMENTS.

Leadership

Management Competencies
  1. Managing Vision and Purpose
Formulates a future course that reflects needs of own area or project and that is aligned with the organization wide vision. Translates the course into goals and objectives for own team, sets priorities, and directs the efforts of staff toward accomplishing those goals and objectives.
  1. Change Management / Learning Agility
Learns quickly when confronted with new problems or situations. Enjoys the challenge of unfamiliar tasks. Understands and uses top-down and bottom-up levers of change. Leads others in understanding change and building the capacity to anticipate and adapt.
  1. Accountability
Holds team and self-responsible for maintaining the highest possible performance standards and meeting agreed upon commitments even under difficult circumstances.
  1. Service Orientation and Customer Focus
Sets and maintains high standards for service to patients, physicians, and other hospital departments by using patient-focused principles each and every occurrence. Incorporates needs and concerns of diverse constituencies (e.g. patients, physicians, colleagues) into decision making.
  1. Communicating Effectively
Articulates logical and well-founded arguments that support conclusions. Matches communication style to the message and to the audience. Actively solicits opinions from others. Routinely provides others with the information they need to do their jobs through rounding, performance management, and staff meetings.
  1. Giving Feedback
Routinely shares suggestions, advice, and insights on progress toward program and project goals by using such tools as management reports and dashboards. Provides performance feedback that is constructive and actionable and on time and that highlights successes as well as areas for growth and is based on objective metrics. Uses appropriate recognition and rewards to match the situations.
  1. Motivating and Influencing
Inspires staff enthusiasm for and generates commitment to program or project goals. Builds support for changes in direction among people with diverse interests, needs, and values. Coaches for superior performance.
  1. Building and Strengthening Relationships
Builds and maintains long-term relationships with others based on mutual respect and trust. Fosters cooperation and collaborative decision-making among staff with diverse backgrounds and interests. Works effectively toward solutions and compromises that take the needs of all parties into account when conflict does arise. Uses effective emotional intelligence to create long-lasting and effective relationships.
  1. Organizational Savviness
Understands the origins and reasons behind key policies, practices, and procedures. Knows how to get things done using formal and informal channels in the organization. Understands the organizational culture. Provides regular updates on program or project progress and works with own manager to minimize risks and resolve problems. Uses effective communication to inform senior management regarding project progress.
  1. Initiative
Recognizes and acts on opportunities for growth and improvement to advance hospital, clinics, and system goals. Confronts problems quickly and enthusiastically.
  1. Constructive Thinking
Analyzes problems systematically and logically, and is resourceful when developing and implementing solutions.
  1. Financial Acumen
Applies key financial concepts and analysis to decision making. Understands drivers of financial performance (e.g. physician referrals, capacity utilization, payment denials) and takes these into account in developing strategies and making decisions.
  1. Process Management
Develops and implements work plans with actionable components and measurable outcomes using continuous improvement processes. Proactively monitors key performance indicators and displays that information through dashboards and metrics and makes real time adjustments to ensure that projects stay on track.
  1. Prioritizing and Delegating
Regularly reassesses priorities and competing demands and adjusts allocation of own and staff time and resources to increase efficiency and effectiveness. Identifies and implements processes that facilitate delegation and shares responsibility and authority with others, leveraging their unique strengths and skills.
  1. Identifying, Developing and Retaining Talent
Effectively manages job descriptions and job expectations to attract highly skilled staff members to position openings and project teams. Defines development objectives for staff that support performance goals and progress toward future skill development. Assists staff in developing their own careers by encouraging them to articulate their career goals, offering challenging growth opportunities, and providing necessary coaching and training.

Physical Requirements / Working Conditions Form

Job Title: / Department: / Supervisor / Manager
Employee Name: / Circle One:
New Hire / Transfer / Annual Review / Update

Physical Demands

Activity
(Hours per day) / Never
0 hours
0 % / Occasionally
Up to 3 hours
1%~37% / Frequently
3-6 hours
38%~75% / Constantly
6-8+ hrs
76%~100%
Sitting / x
Walking / x
Standing / x
Bending (neck) / x
Bending (waist) / x
Squatting / x
Climbing Up or Going Down / x
Kneeling / x
Crawling / x
Twisting/Turning(neck) / x
Twisting/Turning (waist) / x

Repetitive Motion Actions

Activity
(Hours per day) / Never
0 hours / Occasionally
Up to 3 hours / Frequently
3-6 hours / Constantly
6-8+ hrs
Hand Use : Dominant hand Right ( ) Left ( ) / x
Is repetitive use of hands required? / x
Repetitive use of hands for keyboard/data entry? / x
Simple grasping/holding (right hand) / x
Simple grasping/holding (left hand) / x
Power grasping/holding (right hand) / x
Power grasping/holding (left hand) / x
Fine Manipulation (right hand) / x
Fine Manipulation (left hand) / x
Pushing & Pulling (right hand) / x
Pushing & Pulling (left hand) / x
Reaching (above shoulder level) / x
Reaching (below shoulder level) / x

Lifting/Carrying* Pushing/Pulling*

Lbs / Never
0 hrs / Occasionally
Up to 3 hrs / Frequently
3-6 hrs / Constantly
6-8+ hrs / Height / Never
0 hrs / Occasionally
Up to 3 hrs / Frequently
3-6 hrs / Constantly
6-8+ hrs / Height
0-10 / x / x
11-15 / x / x
16-25 / x / x
26-50 / x / x
*51-75 / x / x
*76-100 / x / x
*100+ / x / x

*Assistance for lifting/carrying greater than 50 lbs; and lifting, transferring and repositioning patients.

Hearing – The typical noise level for the work environment is: Check applicable

Very Quiet ( ) Quiet ( ) Moderate Noise ( x ) Loud Noise ( ) VeryLoud Noise

Ability to hear telephone conversations / Yes / No
Ability to hear alarms on equipment / Yes / No
Ability to hear client call / Yes / No
Ability to hear instructions from physician/staff? / Yes / No

Exposure/Equipment/Machinery

Does the job require: / Yes / No
  1. Annual TB surveillance – all employees with direct patient contact (with or without potential bloodborne pathogen exposure).
/ Y / Mandatory
  1. Working with biohazards such as: bloodborne pathogens, sewage, medical waste, etc? ( reference Infection Control Manual: Bloodborne Pathogen)
/ Y / Hep B - CDC requires Waiver if declined. (i.e. giving injections, handling lab specimens, facilities maintenance)
c. Wearing an N95 respirator mask as defined by HR Policy:? Reasons – at risk for exposure to aerosol transmissible diseases (i.e. TB, H1N1, etc.) or Chemotherapeutic Hazardous Drugs. / N / Manager submits updated Physical Requirements Form to HR and/or designated occupational health clinic.
Working with hazardous drugs as defined by HR / N / Manager submits updated Appendix C Physical Requirements Addendum B Formto HR and/or designated occupational health clinic.
d. Exposure to chemicals, fumes, dust, or gas? / Y / (i.e. formalin, gluteraldehyde. etc.)
e. Working around equipment and machinery? / Y
f. Use ofspecial visual or auditory protective equipment? / N
g. Driving a UHA owned vehicle? / N
h. Working at heights? / N
i. Walking on uneven ground? / N
j. Exposure to excessive noise? / N
k. Exposure to extreme in temperature, humidity or wetness? / N
l. Operation of foot controls or repetitive foot movement? / N
m. Risk of electrical shock? / N
n. Risk of radiation exposure or use of Class 3B or 4 lasers? / N
o. Risk of vibration? / N
p. A sense of touch? / N
q. Working in confined spaces? / N

Vision Requirements Yes/No

Color Vision (ability to identify and distinguish colors - Ishihara Test) / Y
Close Vision (clear vision at 20 inches or less) / Y
Distance Vision (clear vision at 20 feet or more) / Y
Peripheral Vision (ability to observe an area that can be seen up and down or the left and right while eyes are fixed on a given point) / Y
Depth Perception (three-dimensional vision; ability to judge distances and spatial relationships)
Ability to adjust focus (ability to adjust eye to bring an object into sharp focus) / Y
No special vision requirements / N
Specific demands not listed:

Verification of Job Description Review

1. Are there any conditions noted in the Job Description that preclude you from performing the essential duties of this job? Yes / No

2. Do you require any accommodations to perform the essential duties of this job? Yes / No

3. Are there any obstacles that will hinder or prevent you from performing this job? Yes / No

4. Do you require any modifications or enhancements to the workspace to perform this job? Yes / No

Employee Signature Date ______

Print Name ______