Medical Director

JOB TITLE: Medical Director STATUS: Exempt

REPORTS TO: Chief Medical Officer DEPT: PACE

DATE: October 2021 LOCATION: Los Angeles, CA

JOB SUMMARY

ConcertoPACE of Los Angeles is looking for an energetic, mission-driven, and ownership-oriented physician to lead medical care for our frail and elderly participants. In partnership with the Executive Director, the Medical Director is accountable for all financial, clinical, and operational outcomes of the PACE program as a health plan and care delivery system. This role is responsible for the delivery of clinical care across the full spectrum of care needs, clinical outcomes, and oversight of the quality assessment and performance improvement program. The ideal candidate is excited to build a program from the ground-up with a dynamic leadership team to serve the senior population of LA and enable them to lead full lives.

The Medical Director is a culture champion for the team, inspiring the PACE program to deliver world-class, value-based care for the frail, underserved elderly. The role is responsible for implementing the PACE program’s model of care, assessment tools, risk stratification processes, and effectively integrating the clinical team with the broader interdisciplinary team and care planning process. The Medical Director also serves as the program’s liaison to the local, regional, and national medical and PACE communities. Finally, as a physician member of the interdisciplinary team, the Medical Director provides direct medical care to program participants during launch and for the program’s early phase, in addition to administrative duties as outlined below. As the program matures and enrollment expands, the Medical Director will also serve as the consultant and resource to a primary care physician, on-call physicians, and nurse practitioners.

ConcertoPACE of Los Angeles is a partnership between ConcertoCare and Edenbridge Health to bring superior, integrated care to the frail elderly. This partnership combines Edenbridge Health’s deep expertise in the PACE model of care with ConcertoCare’s experience in leading Medicare and Medicaid risk-bearing provider entities.

ESSENTIAL DUTIES AND RESPONSIBILITIES

The Medical Director serves as the co-lead of market in partnership with the Executive Director. This dyad is accountable for all clinical, operational, member satisfaction, and financial outcomes under the oversight of the PACE Board of Directors. The Medical Director takes strategic lead on and is jointly accountable for meeting performance targets such as admission avoidance (ADK), emergency department avoidance (EDK), SNF day management, clinical quality, and utilization management. In addition to health plan domains of performance, the Medical Director is accountable for deploying a geriatric model of care and managing associated clinical outcomes such as fall reduction, simplification of medical plans (de-prescribing, etc.), and other clinical quality measures to be determined.

Direct Clinical Care Delivery

• Leads clinical practice efforts and provides clinical supervision for all medical care delivered through the program. Implements evidence-based clinical practice guidelines while basing decisions on each participant's goals and preferences for care. Manages to accountable KPIs and leverages metrics and data to make decisions.
• Directly supervises employed providers, including other physicians, nurse practitioners, physicians’ assistants, etc. Builds and retains high quality clinical teams that are aligned with ConcertoCare’s value-based care delivery model. Ensures team success through training, supervision, performance management, and retention of direct and indirect reports.
• Provides internal consultation to the primary care physician and nurse practitioners.
• Delivers direct care or oversees effective care delivery by ConcertoPACE employees in inpatient, emergency, sub-acute, and in-home settings.
• Maintains and participates in on-call schedule for providers.
• Participates in interdisciplinary team as the primary care physician, whose members collaboratively develop individualized care plans for each participant
• Fosters a collaborative culture and effective teamwork between disciplines on the Interdisciplinary Team.
• Develops and implements company-wide clinical playbooks that improve the quality of or reduce the cost of care for program participants.
• Supports the development and implementation of new clinical initiatives and champions the change with the local team for national operational workflows, technology innovation.
• Provides direct patient care. Serves as the initial staff physician of the program. Portion of time dedicated to direct patient care is estimated to be between 50-70%. Actual dedicated patient care time will fluctuate with need as the program scales.

Network Operations, Coordination of Care, and Utilization Management

• Coordinates care with contracted providers in the PACE program’s network to meet desired clinical outcomes. Maintains oversight of quality of care delivered by provider network.
• Builds and maintains strong relationships with physician groups, specialists, contracted providers, hospitals, and skilled nursing/post-acute rehab facilities to strengthen these partnerships and enhance referrals.
• Monitors quality of care delivered by network provides and is accountable for utilization management for enrolled participants.
• Coordinates effectively with contracted vendors responsible for various health plan functions such as claims, pharmacy benefits management, etc.
• Provides input to the Executive Director regarding clinical needs within the contracted network to ensure adequate patient care.

Quality, Compliance, and Advocacy

• Oversee the Quality Assessment and Program Improvement (QAPI) program through participation on the Quality-of-Care Committee; design and conduct quality improvement projects and keep abreast of federal outcomes-based quality improvement initiatives.
• Participate in national quality improvement efforts such as those organized by the National PACE Association, AMDA, CalPACE, and other professional groups.
• Ensure compliance with PACE provider regulations as they pertain to medical/clinical components of care. Serves as physician representative to local, state, and regulatory agencies.

The Medical Director may be tasked with other duties as assigned including but not limited to strategic projects and supporting other clinical needs.

QUALIFICATIONS

• MD or DO degree, with current licensure in the State of California
• Board certified in internal medicine or family practice
• Completion of fellowship or advanced training in geriatrics (preferred)

• Minimum of five years in medical practice for the chronic care population (PACE preferred)
• Experience in a managed care, value-based care, utilization management, and/or quality leadership role in a health plan or provider context required
• Demonstrated skills in medical administration and/or previous experience as a Medical Director
• People management experience, strongly preferred
• Experience working with an interdisciplinary team and performing comprehensive geriatric assessments

• Enthusiasm for geriatric medicine and community-based care for frail elderly people
• Current knowledge of chronic care/geriatric issues and best practices
• Familiarity with applying population health analytics to optimize care for the frail elderly population

ABOUT CONCERTOPACE of LA

ConcertoPACE (Program of All-Inclusive Care for the Elderly) is an integrated, home and community-based care model designed to help seniors maintain their independence and remain part of their communities for as long as safely possible. ConcertoPACE’s tech-enabled in-home care teams leverage our value-based, interdisciplinary care model to address unmet health and social needs and improve patients’ quality of life, partnering with them, their caregivers, families, health providers, and communities.

PACE is a proven, cost-effective care model, saving states an average of 13% versus other Medicaid services, including nursing homes and community-based waiver programs. Concerto’s unique approach to PACE is enhanced by our deep expertise in in-home care, clinical geriatrics, data analytics, and virtual care technology, all for the purpose of improving the health and quality of life of our patients.

We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

ConcertoCare is an Alcohol/Drug/Smoke-Free Workplace

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