Utilization Management Bcba Remote Jobs in Naples, FL

Monogram Health is seeking a mission-driven Market Physician Executive (MPE) to lead its in-home multi-specialty polychronic care model within an assigned market. This role involves overseeing daily clinical and business operations, providing direct and indirect patient care, and collaborating with a multidisciplinary team to improve patient well-being and health outcomes. The MPE will contribute to clinical strategies and ensure adherence to evidence-based clinical pathways, focusing on patient experience, population health, and cost reduction.

Practice Info

• Lead an in-home multi-specialty polychronic care model in an assigned market
• Each market is comprised of 5-10 territories led by local advanced practice providers (APP), registered nurses (RN), licensed clinical social workers (LCSW), and pharmacists
• Collaborate with Monogram Health's Multi-Specialty Platform to leverage employed specialists to deliver in-home specialty care
• Deploy a proven risk-based model to ensure health equity and health equality leveraging proprietary next generation AI algorithms
• Oversee daily clinical and business operations through delivery of direct patient care, care management services, social worker support and pharmacy services within the market
• Direct supervision of front line clinical and operations team members

Responsibilities

• Lead daily high risk and concurrent review rounds
• Oversee and delegate operational responsibility to Market Manager to deliver on daily operations
• Collaborate with Market Leadership to develop and maintain a market culture of clinical excellence
• Regularly assess and present market performance and outcomes to Executive and Senior Leaders
• Provide direct and indirect patient care (including diagnosis and treatment of acute and chronic diseases)
• Engage with patients on treatment plans, community provider collaboration, and direct evidence-based care pathways
• Conduct Peer to Peer consults with community, facility, and health plan partners
• Provide clinical guidance and direction to Market teams to drive Population Health Management activities

Compensation

• Competitive compensation
• 401k with employer match

Benefits

• Medical, dental, and vision insurance
• Employee assistance program
• Employer-paid and voluntary life insurance
• Disability insurance
• Health and flexible spending accounts
• Financial wellness resources
• Paid holidays
• Flexible vacation time/PSSL
• Paid parental leave
• Work life assistance resources
• Physical wellness perks
• Mental health support
• Employee referral program
• BenefitHub for employee discounts

Shift & Schedule

• This position will be remote within the designated market with occasional in-home patient treatment visits and occasional domestic travel
• Participate in Monogram On-Call rotation which will vary; e.g. 7 days on call minimum once/quarter
• Provide coverage for other MPEs, during PTO or vacancy, as needed

Requirements

• Current state medical license without restrictions to practice and free of sanctions from Medicaid or Medicare
• Willingness to become licensed in multiple states
• MD or DO degree from an accredited medical school
• BC or BE in an ACGME approved specialty such as Nephrology, Internal Medicine, Family Practice, Emergency Medicine, Critical Care, Cardiology, Endocrinology, Hepatology, or Geriatrics
• Active, unrestricted state medical license required in each state within the market, and ability to obtain additional states as needed
• Demonstrated experience applying evidence-based clinical criteria
• Experience in multispecialty, geriatrics and/or value-based care
• Advanced management and communication skills
• Experience with high need Medicare Advantage and managed Medicaid populations
• Experience with NCQA, HEDIS, Medicaid, Medicare, quality improvement, medical utilization management, and risk adjustment