Medical Director responsible for managing clinical operations and providing strategic advice at Elevance Health. Overseeing health services and ensuring quality and cost - effectiveness in care delivery.
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Onsite Admitting Physician Program Clinical Director
Posted yesterday
About the role
- Clinical Director developing and implementing strategies for Admitting Physician Program and Inpatient Management. Ensuring compliance, metrics evaluation, and overseeing clinical guidelines with various healthcare agencies.
Responsibilities
- Develops, implements, and monitors the efficient implementation of Admitting Physician Programs.
- Evaluates program data, trends, and results and sets priorities to reach program goals and objectives.
- Monitors that the appropriate care coordination is carried out between the Admitting Physician and the different Service Providers in charge of member management.
- Ensures compliance with corrective action plans for internal and/or external situations to ensure compliance with the established goals.
- Manages the Admitting Physician Program meetings or Committees and proposes recommendations for adjustments to the Program according to the results.
- Oversees the development, revision, and dissemination of clinical guidelines to the program participants, in conjunction with AP Medical Directors.
- Develops metrics, evaluates, and monitors clinical and service indicators for hospital services to avoid over- or under-utilization trends and ensure appropriate care outcomes for hospitalized patients by the Admitting Physician Program.
- Monitors the incentives and compensation plan corresponding to the Admitting Physician Program, to ensure that these are correct and per the established agreements.
- Ensures regulatory, contractual, and accreditation compliance required for the program, as well as compliance with Company policies and procedures.
- Prepares the annual review and evaluation of the Admitting Physician Manual to ensure compliance with organizational goals and objectives.
- Analyzes industry standards by attending training sessions or conferences and/or through literature to evaluate or establish processes in the Program.
- Proposes models and evaluates the Company's business proposals concerning the Admitting Physician Program.
- Conducts and/or attends meetings with Hospitals, IPA Administrations, and/or other agencies to ensure the relationship and compliance with the goals established through the Admitting Physician Program.
- Proposes, evaluates, and actively participates in the implementation process of the new Admitting Physician Programs in conjunction with the Administrative Director of the Program.
- Supervises, monitors, trains, evaluates, and corrects personnel among others to comply with his/her role as a supervisor, to assure that his/her personnel fulfill their work plan and comply with their essential functions and that they behave following the policies, standards, norms, and procedures of the Company.
- Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
- May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.
Requirements
- Doctorate in Medicine and/or Physician Assistant.
- At least seven (7) years of experience performing managerial functions in health care coordination, providers, hospitals, capitated agreements, or similar areas. Which includes four (4) years of experience supervising personnel.
- An active medical license to practice in Puerto Rico is required.
- A driver's license valid in the Commonwealth of Puerto Rico is required.
- Knowledge of the regulations applicable to the Health Industry and/or Medical Plans.
- Availability to work extended hours and weekends, and visit different points on the island.
- Intermediate Excel proficiency.
- Spanish – Advanced (comprehensive, writing and verbal)
- English – Advanced (comprehensive, writing and verbal)
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