Utilization Management Medical Director Md Jobs

Abode Care Partners

The Regional Medical Director (RMD) reports to the Chief Medical Officer and serves as the senior physician leader for an assigned geographic region within Abode Care Partners. The RMD is accountable for clinical quality, provider performance, adherence to the Abode Care Partners Model of Care, and execution of clinical and value-based initiatives across a distributed practice serving medically complex older adults, with particular emphasis on skilled nursing facilities (SNFs), assisted living facilities (ALFs), long-term care, home-based care, and other post-acute settings.

The RMD directly manages Regional Clinical Directors and provides clinical and managerial oversight of physicians and advanced practice providers (APPs) in the region. In a dyad leadership structure, the RMD partners closely with the regional operational leader to translate clinical strategy into reliable day-to-day execution across staffing, access, provider performance, clinical workflows, quality, utilization, and growth.

The RMD maintains an active clinical practice representing approximately 25-50% of total effort, with the exact allocation based on regional needs and leadership scope. Clinical work may include SNF and ALF visits, home-based primary care and home visits, telehealth, complex or high-risk patient care, transitional care, and facility medical directorship responsibilities. Active practice keeps the physician leader engaged in frontline patient care and provides direct insight into clinical workflows, operational barriers, and the needs of the population served.

·       Regional Clinical Leadership & Accountability

·       Quality of Care, Model-of-Care Adherence & Medical Decision-Making

·       High-Risk Population Management & Avoidable Hospitalization Prevention

·       Provider Education, Training & Clinical Development

·       Documentation, Coding & Clinical Record Quality

·       Clinical Practice

·       Post-Acute, Skilled Nursing & Assisted Living Leadership

·       Medical Group Policies, Procedures, Clinical Standardization & Strategy

·       Value-Based Care & Population Health

·       Provider Efficiency, Productivity & Capacity

·       Dyad Partnership With Operations

·       Provider Recruitment, Onboarding, Performance & Retention

·       Collaborating / Supervising Physician Responsibilities

·       Facility, Partner & External Relationships

·       Clinical Quality, Safety & Compliance

·       Leadership Development & Organizational Growth

·       Supervisory Responsibility

·       Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree from an accredited medical school required.

·       Successful completion of an accredited residency in Internal Medicine, Family Medicine, Geriatrics, or another specialty appropriate to the population served required; board certification in a relevant adult            primary care specialty strongly preferred.

·       Five or more years of post-residency clinical experience preferred, with meaningful experience caring for older adults and medically complex populations.

·       Three or more years of progressive physician leadership experience strongly preferred, including direct management of physicians and/or advanced practice providers; experience managing managers or            clinical leaders is highly desirable.

·       Experience in value-based care, Medicare Advantage, accountable care, population health, risk-bearing arrangements, or utilization-focused clinical models preferred.

·       Direct experience in post-acute care, skilled nursing facilities, long-term care, assisted living, home-based primary care, geriatrics, hospital medicine, palliative care, or closely related settings strongly                  preferred.

·       Experience developing and implementing clinical policies, procedures, care pathways, quality initiatives, or standardized models of care preferred.

·       Experience leading interdisciplinary teams and using clinical and operational data to improve quality, utilization, provider performance, and patient outcomes preferred.

·       Experience serving as a SNF Medical Director or familiarity with facility medical directorship responsibilities preferred.

·       Experience serving as a collaborating or supervising physician for nurse practitioners or physician assistants preferred.

LICENSE/CERTIFICATION/OTHER SPECIAL REQUIREMENTS

·       Active, unrestricted physician license in at least one state within the assigned region required; ability and willingness to obtain additional state licenses as needed.

·       Current unrestricted DEA registration and ability to meet payer, facility, credentialing, and medical staff requirements required.

·       Ability to maintain all required professional credentials, malpractice coverage, training, and compliance requirements.

·       Valid driver license and ability to travel locally between facilities, patient homes, and regional markets as required.

·       Ability to work effectively in a distributed, multi-site, and potentially multi-state environment and to respond to time-sensitive clinical or operational escalations when needed.

KNOWLEDGE/SKILLS/ABILITIES

·       Strong physician leadership and people-management skills, including coaching, accountability, performance management, difficult conversations, and leadership development.

·       Strong clinical judgment in the management of medically complex older adults, including recognition of acute change in condition and decisions regarding treatment in place, escalation, transfer, and goals            of care.

·       Working knowledge of post-acute and facility-based care delivery, including SNF and ALF clinical workflows, transitions of care, interdisciplinary collaboration, and physician/APP practice models.

·       Understanding of value-based care principles, quality improvement, utilization management, population health, HEDIS/Star performance, risk adjustment, documentation integrity, and total-cost-of-care                drivers.

·       Ability to interpret clinical and operational data, identify meaningful variation, prioritize opportunities, and translate data into actionable plans for providers and regional leaders.

·       Strong educational and presentation skills with the ability to teach evidence-based medicine, medical decision-making, common post-acute clinical conditions, and new workflows to physicians, APPs,                  nurses, and operational partners.

·       Ability to effectively engage, coach, and influence physicians, APPs, and Regional Clinical Directors while fostering a culture of accountability, collaboration, and continuous improvement.

·       Strong dyad leadership skills and ability to collaborate effectively with operations, quality, finance, revenue cycle, compliance, human resources, credentialing, and other functions.

·       Strategic thinking, executive presence, sound judgment, adaptability, and strong written and verbal communication skills.

·       Comfort operating in a fast-paced, geographically dispersed organization with competing priorities, significant autonomy, and a high degree of accountability.

Abode Care Partners, an affiliate of BrightSpring Health Services, is a leading provider of integrated medical services, caring for individuals from post-hospitalization to home in various settings ranging from skilled nursing facilities, assisted living, independent living, group homes, and private homes. We bring quality medical care to older adults, people with complex conditions, people with special needs, and individuals with intellectual and/or developmental disabilities while increasing quality of life and safeguarding the dignity of those we serve. For more information, please visit www.abodecarepartners.com. Follow us on Facebook, LinkedIn, and X.