Director Operational Risk Jobs in Georgetown, SC

Founded in 2017 and headquartered in Nashville, Tennessee, Upperline Health delivers comprehensive care through a growing national network, with teams spanning podiatry, endocrine, primary care, urgent care, wound, vascular and more. The organization’s mission is to integrate and transform specialty care for chronically ill, high-risk patients through frequent specialist engagement and coordinated, value-based programs.

With a patient-centered approach, Upperline delivers care across 21 states and has been recognized as one of the nation’s largest multi-specialty physician practices. The platform has demonstrated meaningful improvements in outcomes, such as lowering hospitalization rates, decreasing total cost of care, reducing amputations, and accelerating wound-healing times, supported in part by its optimized EHR and analytics infrastructure.

Our Upperline Plus program is the value-based care pillar of Upperline, which allows for the integration of primary and specialty care. Patients are part of full risk arrangements with Medicare and MA plans, and the Upperline Plus interdisciplinary team extends an extra layer of support for high-risk patients. This care model - a full interdisciplinary team (physicians, APPs, RNs, pharmacists, social workers) working across clinics, home, and telehealth - reduces avoidable utilization and total cost of care.

The Upperline team enhances the healthcare experience by living our Upperline CARES values—fostering strong Connections, holding ourselves to the highest level of Accountability, demonstrating Resilience in navigating and tackling complex challenges, committing to Excellence in patient care, and focusing on a Service mentality that places patients at the heart of everything we do.

Upperline is seeking a Medical Director, Value Based Care (VBC) to join the clinical leadership team in developing, implementing, and growing our unique value-based care model in the Myrtle Beach, SC market. The VBC Medical Director will serve as a clinical leader partnering with Operations and Population Health leaders to deliver successful value-based care results across the market.

• Oversee the care management and medical management of the Upperline Plus patients being seen by Upperline’s Nurse Practitioners in the in the market or region
• Responsible for supervising medical management of patients in the region including clinical quality review of providers and serving as the collaborating physician for APPs in the region (as necessary based on state law)
• Accountable for value-based care outcomes (e.g., ADK, total cost of care), medical management, care management, utilization management, and quality improvement tools and processes in the region
• Manage and drive value-based care initiatives with APPs and doctors ensuring positive impact on patient outcomes
• Analyze population health data and identify gaps and develop solutions to improve delivery of care, decrease hospitalizations and reduce medical costs
• Educate providers on value-based care metrics and best practices and foster a culture that prioritizes accountability around outcomes-based performance
• Ensure the region is meeting VBC operations metrics such as addressing Quality gaps, accurate documentation, patient engagement and retention
• Design, implement and manage new value-based care programs and service lines in collaboration with population health and operations teams
• Conduct interdisciplinary team meetings to discuss management of the most complex patients (including high cost and high-risk patients)
• Establish and maintain relationships with VBC team, specialists, and PCPs in the region; educate on Upperline Plus program and advocate for collaborative partnerships benefiting patients
• Support onboarding and training of new providers and provide onsite and virtual clinical coaching and feedback with a focus on ensuring consistency and continuous improvement of managing patients more efficiently
• Build relationships in the region and identify best partners (e.g., other specialists, home health agencies, hospitals) for Upperline to send referrals when needed
• Develop clinical compliance guidelines and protocols

• Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.)
• Board certified in Internal Medicine, Family Medicine, Preventative Medicine, or Geriatrics
• Active license in South Carolina and willing to pursue multi-state licensure if needed
• Fellowship training in Geriatrics and/or other advanced degrees (e.g., M.B.A., M.P.H., M.H.A.) valued but not required
• ~ 5 years of outpatient practice experience
• Clinical leadership experience in a VBC or Population Health company
• Experience with managed care and familiarity with payer-provider collaboration
• Owned or been part of creating, improving, and/or implementing clinical processes, protocols, or evidence-based guidelines
• Experience or exposure to rolling out and/ or managing VBC programs (e.g. Transitional Care Management, Complex Care Management, ED Diversion, Advanced Care Planning, High Risk Patient Outreach)
• Talent for synthesizing information and solving complex problems; can independently translate high-level goals into actionable plans
• Proven leadership skills and servant leadership mentality with a passion for people and culture
• Ability to communicate, collaborate and work effectively with staff, providers, and organizational leaders
• Self-starter with a bias for action orientation; demonstrates a service excellence mindset
• Exceptional organizational and project management skills and the ability to prioritize and multi-task autonomously
• Comfortable working in Excel; able to analyze data and present findings
• Must be willing and able to routinely visit clinics and providers within the region; Residing in the market or region is strongly preferred

Comprehensive benefit options include medical, dental and vision, 401K, PTO, and parental leave.

Compensation is commensurate to compensation for similar positions in the region and based on prior training and experience.

Job Type: Full-time