Assistant Regional Medical Director (Physician #)
Company: Landmark Health
Location: Winston Salem
Posted on: May 18, 2019
OBJECTIVE Responsible for assisting the Regional Medical Director
in providing the means, structure, and environment to most
effectively and efficaciously utilize the resources that are
available to ensure that all enrolled members have access to
appropriate medical care, and are provided with opportunities for
health promotion and health maintenance as an administration of
their individual Health Plan benefits in conjunction with
additional community resources identified as meeting member care
- Manage a panel of high utilizer patients, across all PODs,
which are selected by the RMD and POD leaders with the goal of
positively directing their care seeking value while decreasing
unnecessary emergency department visits and hospitalizations. High
utilizer patients will rotate off the panel and back to the POD
longitudinal provider every 60-90 days as decided by the RMD, A-RMD
and POD leaders.
- Act as the lead clinician for a majority of the markets D
acuity patients across all PODS. Work with HSD and Clinical
Supervisors to properly identify D patients who need to have a
higher acuity and work with POD leaders to accept higher acuity
patients as a D patient. Constantly re-assess the panel to assure
proper acuity designation and provides direct or virtual visits as
allowed and supervise other Landmark clinical staff (FT, PT and PD)
to make visits to provide medical care and education and accurately
capture HCC diagnosis and close quality gaps.
- Assist in the development of, documentation, implementation,
and interpretation of local medical policies and procedures.
- At the direction of the RMD assists and as needed leads the
Interdisciplinary Care Team Meetings (IDT)
- At the direction of the RMD, oversees provider education,
in-service training and provider orientation.
- Participates in Medical Director Conferences.
- Remain current in the knowledge of geriatrics, utilization
management, quality management, managed care principals and new
clinical developments and technologies.
- At the direction of the RMD interact with local attending
physicians on application of the Landmark Health model and issues
regarding medical practice.
- Assist in supporting the program within the community and
assist in the development of local business opportunities for
furthering the cause of the program.
- At the direction of the RMD assist in resolving conflicts
between physicians and among physicians, members, and Landmark
- Meet/confer periodically via telephone or in person, with the
Program Director, VP of Medical Services and other Landmark Health
management regarding local issues including patient care plans and
authorizations for service.
- Assist in providing Primary Care Physician Services to members
in the event that the member's PCP is unavailable.
- Takes an active role in reviewing and discussing all items
pertaining to Utilization Management.
- Assists in identifying requests that require additional review
by specialist in a particular field, and assists in establishing a
review process with these specialists whenever necessary.
- Supports the Health Services staff in carrying out all UM
- The Medical Director is responsible for oversight of the
Utilization Management process. This includes, but is not limited
to the following:
- Referral request determinations
- Medical Necessity Denial of requests (with consultation with a
specialist as needed)
- Acting as Chairperson of the Utilization Management Committee
and the Quality Improvement Committee (if unable to attend, then
Medical Director will arrange for his/her "designee" to perform
- Review of policy and procedures
- Direct communication with individual providers regarding UM
- At the direction of the RMD delegates direct intervention and
decision-making regarding the approval and authorization of medical
care and services to the appointed POD Leaders as needed within the
structure of the established decision-making processes in support
of eliminating potential conflict of interest.
- Participates in the continuous assessment and improvement of
the quality of care provided to members through Quality Improvement
- Participates in the surveillance of provider performance in
conjunction with the Quality Improvement activities.
- Assists in the development, implementation, and evaluation of
the Quality Improvement Program.
- At the direction of the RMD participates in the resolution of
medically related grievances.
- Participates in provider recruitment activities related to the
areas of network expansion, key to identifying additional
providers/specialists needed for the network based on target
population needs including providers and facilities in target
population medical, mental health specialty services across all
- At the direction of the RMD reviews and makes recommendations
to the Credentialing Committee regarding the appointment and
re-appointment of panel providers.
- Participates actively in the management of provider's contract
status within the provider panel to ensure the delivery of quality
based health care while supporting the protections of the
provider's rights as well as Landmark Health's obligations for
oversight and reporting.
- Participates actively in all Peer Review activities. EDUCATION
- Medical Doctor currently licensed to practice without
restriction in the state of practice, and has met or exceeded all
the credentialing requirements of a provider within the provider
- Current in the knowledge of geriatrics, utilization management,
quality management, managed care principals and new clinical
developments and technologies.
- Have significant experience in leading teams of physicians and
mid-level providers in delivering high quality, cost effective
- Experience in recruiting and hiring medical talent along with
continuous supervision of the medical care delivered.
- Ability to analyze staffing needs sufficient to care for the
- Experience in coaching members of the health care team to
provide excellent care or, if needed, determine deficiencies in
care and formulate a plan for improvement. Keyphrases: family
medicine jobs, family practice jobs, family practitioner jobs,
geriatric medicine jobs, geriatrician jobs, gerontologist jobs,
family medicine specialist jobs
Keywords: Landmark Health, Winston-Salem , Assistant Regional Medical Director (Physician #), Healthcare , Winston Salem, North Carolina
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