Department: Network Engagement
Status: Regular, FLSA Exempt
Location: SeaTac, WA and/or Home
Reports to: Senior Network Medical Director
In support of Optum Care Networks (OCN) mission, vision, and strategic goals as an emerging Clinically Integrated Network, the Network Medical Director (NMD) is the accountable leader for performance in population health programs within their designated Pod or region. This role provides direction, coordination, support and accountability throughout the OCN network including Primary care practices of various sizes, multispecialty groups, hospitals, and ancillary facilities such as lab, imaging, and post acute care settings. The NMD reports of the Senior Network Medical Director. This role supports the Chief Medical Officer and Network Management Executive Leadership Team regarding all elements of performance throughout the network including adherence to quality performance, timely access for patients, appropriate and accurate documentation and coding, patient engagement, practice engagement with central supports like care management programs provided by OCN, analytic platforms, wrap around care services.
ESSENTIAL DUTIES & RESPONSIBILITIES
The duties listed below are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment.
- Sets and implements clear standards and expectations for the professional performance of the providers in the OCN network.
- Willingness to travel within Washington State on a regular basis as needed
- Lead onboarding discussions with new practices joining the network (setting appropriate and customized performance expectations in collaboration with the practice)
- Collaborate with the practice engagement project manager, director of engagement, executive medical director, and leaders within OCN, TEC and Polyclinic to prioritize initiatives and identify the ideal implementation plan for network participants as appropriate.
- Prepare and present high quality educational content related to Population Health and Risk Adjustment diagnosis, coding and documentation in both formal presentations and off the cuff at impromptu opportunities.
- Assists in teaching clinicians and management team about Medicare Risk Adjustment, Star ratings, and overall population health approach to patient care.
- Direct the Clinical Educators to provide high quality education to providers and staff within OCN and the employed groups.
- Assists in coordinating efforts between network partners who are part of different organizations (primary care site, and various specialties who are each in different organizations).
- Assists in the roll out of Optimal Care clinical guidelines where appropriate at the direction of the quality committee.
- Align work of Risk Adjustment, Quality, and affordability initiatives internally and translate into ways network practices can actively engage in easily using these resources
- Collaborate with employed medical groups and network medical groups in a positive way while identifying opportunities for alignment of regional activities (ie. Care management/affordability initiatives, quality initiatives, new care models).
- Set a tone of service and collaboration, leading the respective Pod in dyad partnership with the Regional Manager and the designated Practice Engagement Managers.
- Provide secondary assistance in supporting the contracting team, discussing with provider groups the value proposition for joining the network.
- Represent the voice of network practices on committees at the request of the CMO.
- Be available when asked, to report to the Quality Committee, Regional Executive committee, or Provider Meetings.
- Works with the Medical Director for Quality and Safety to support integration of Quality Improvement programs, Daily utilization Management reports, and Disease Management programs.
- Support patient safety initiatives.
- Support patient experience initiatives, including patient satisfaction and access.
- Supports ongoing improvements to the Primary Care Model of care with an emphasis on sustainability, comprehensive primary care delivery, quality performance and patient experience.
- Collaborate with regional leaders on Care Coordination to understand and support reductions in cost of care through appropriate institutional utilization and resource management by the service line.
- Assures that utilization of hospital care is appropriate and consistent with well-managed national and regional benchmarks.
- Assist in planning and implementation of lower cost alternatives to institutional care where appropriate
- Assure utilization of advanced imaging and prescribing is consistent with national and regional benchmarks.
- Ensure optimal specialty utilization and appropriate site of service (ASC vs hospital)
- Help lead the primary care departments to focus on access and reduced inappropriate ER utilization.
KNOWLEDGE, SKILLS, AND ABILITIES
- Be flexible and able to quickly customize the conversation with contracted groups at various stages of population health development.
- Well versed in guiding conversations with clinicians, operations teams, and executive leadership in various organizations.
- Proven track record of working well with Physicians, ARNP, Physician Assistants, Coders, Schedulers, Managers, Directors and Executives to assure care delivery is patient centered, timely, effective and evidence-based approach to clinical care across all Primary Care and specialty care participants
- Serves as an ambassador for OCN among network providers
- Knowledge of managed care, including utilization, care management, quality, credentialing, and peer review
- Advanced knowledge of Medicare and Medicaid plan design and coverage criteria
- Graduate from accredited medical residency program
- Masters Degree in Business Administration, Hospital Administration or equivalent preferred.
- 5 years recent experience in clinical practice
- 5 years minimum experience in physician leadership role in medical facility or related environment.
- Current unrestricted Physician (MD/DO) license for the State of Washington
- Current drivers license
Office equipment, computer, personal vehicle
MENTAL & PHYSICAL DEMANDS/WORKING CONDITIONS
- Mental Effort: Must be able to work effectively as a member of OCN team; work is detailed and complex with multiple competing priorities, deadlines and internal and external customers
- Physical Requirements: Work is primarily from home and in the field including on site engagement with network partners and periodic in person team meetings requiring ability to see and hear and communicate as well as operate personal motor vehicle
- Working Conditions: Work is performed from home, in an office setting and at clinic locations; noise level may be moderate or loud on occasion; work may be required outside normal business hours
The job description does not constitute a written or implied contract of employment. NPN reserves the right to revise or change job duties and responsibilities as the need arises.