Medical Director - Sentara Quality Care Network
Sentara Healthcare is currently recruiting for a Medical Director for the Sentara Quality Care Network (SQCN).
The Sentara Quality Care Network (SQCN) is a clinically integrated network with over 2,000 providers located in the Hampton Roads and Charlottesville region of Virginia. This network of physicians, hospitals and other providers is the first such network of this kind within these regions. The goals of the Sentara Quality Care Network are to improve the quality of care and create value for patients, providers, and payers.
This position will partner with the Sentara Quality Care Network (SQCN) President and Sentara CVP for System Integration, and will be responsible for oversight of quality, safety, efficiency and effectiveness of the medical care provided by SQCN and its Participants. The Medical Director (SQCN) will also serve as a medical manager and policy advisor to the SQCN President, SQCN committees, and participating practices.
Responsibilities will include accountability/oversight, leadership and direction related to the Quality Improvement Program and clinical quality management functions. Works collaboratively with other Sentara Healthcare functions that interface with SQCN medical management such as health plan provider relations, member services, benefits and claims management, hospital credentialing, quality and peer review committees, etc. Assists in short and long range program planning, quality improvement and developing external relationships. Works with the SQCN Board of Managers and appropriate Sentara divisions for support, assistance and direction in overall medical management effectiveness. Collaborates with the SQCN President and other Network medical directors on medical policies and carries out medical policies at the Network in collaboration with the SQCN President and Committees.
1. Responsible and accountable to the SQCN President for helping to assure appropriate health care delivery for SQCN's products and services. Reports organizationally to the SQCN President of the Network.
2. Plans, organizes, and directs the professional medical services program
3. Participates in the design and implementation of Network medical policies, goals and objectives.
4. Leads the design and development of SQCN quality improvement program and care improvement initiatives. Works closely with the Chair of the SQCN Performance Improvement Committee.
5. Responsible and accountable for implementing the quality improvement and care management programs. Assures plan conformance with legal and regulatory requirements.
6. Responsible for and assists with the development of budgets, staffing plans, Network quality and cost improvement targets, and medical loss ratio projections, assuring the adequate allocation of resources to the medical management functions.
7. Assists the SQCN President with activities to promote positive community relations. Participates in key marketing activities and presentations. Represents SQCN at medical group meetings, conferences, etc.
8. Responsible for creating and maintaining a system that gives feedback to providers individually and collectively regarding care effectiveness of individual providers and networks.
9. Assists the SQCN President and Professional Standards Committee in designing and implementing corrective action plans to address issues and improve plan and network care performance.
10. Participates in policy review, performs analysis and makes recommendations.
11. Supports URAC, AHCA and NCQA qualification activities (if applicable). Prepares for site visits and responds to accrediting and regulatory agency feedback.
12. Supports pre-admission review, utilization management, and concurrent and retrospective review process as appropriate.
13. Participates in SQCN risk management, pharmacy utilization management, catastrophic case review, outreach programs, HEDIS reporting, site visit review coordination, triage, nutrition service review, provider orientation, credentialing, profiling, etc. as appropriate.
14. Participates in the grievance process with the SQCN President, insuring a fair outcome for all members.
15. Monitors member and provider satisfaction survey results and implements changes as needed to increase satisfaction and assure that satisfactory relationships are maintained between network and plan participants.
16. Provides periodic written and verbal reports and updates as required in areas of responsibility. Performs other duties as requested or assigned.
Graduation from Medical School and completion of a Residency in a Medical or Surgical Field required. Masters in Public Health, MBA, or MA preferred.
Minimum 5 years of clinical experience in the practice of medicine with two (2) years of management experience as a physician executive in a provider or managed care environment. Experience in Quality Improvement required. Experience or training in a Process Improvement Discipline (Lean, Six Sigma, etc.) preferred.
Unrestricted License to practice within Virginia as a Doctor of Medicine or a Doctor of Osteopathy with an Active license to practice medicine. Certification in a recognized medical specialty as recognized by the American Board of Medical Specialists (ABMS) also required.
Certification by the American Board of Quality Assurance and Utilization Review Physicians or the American Board of Medical Management is preferred.