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VP / Senior Medical Director, Medical Management

Oak Street Health
Gary, IN
  • Expired: over a month ago. Applications are no longer accepted.
Job Description

Company: Oak Street Health

 

Title: Senior Medical Director, Medical Management

Company Description

Oak Street Health is a rapidly growing company of primary care centers for adults on Medicare in medically-underserved communities where there is little to no quality healthcare. Oak Street’s care is based on an entirely new model that is based on value for its patients, not on volume of services. The company is accountable for its patients’ health, spending more than twice as long with its patients and taking on the risks and costs of their care. For more information, visit  http://www.oakstreethealth.com.

Role Description:

The Senior Medical Director, Medical Management is part of Oak Street Health’s central Population Health team and is the clinical leader for the Transitional Care and Utilization Management programs. The Senior Medical Director is responsible for partnering with operational dyad partners to articulate an integrated clinical strategy for both programs, providing clinical leadership to front-line care management staff, providers, and other clinical leaders, building an ecosystem of facility and vendor partnerships, fulfilling delegation and CMS requirements, and driving improved acute and post-acute outcomes.

Core Responsibilities:

  • Transitional Care:

    • Partner with operational dyad leader to define transitional care goals, KPIs, and program strategy

    • Provide clinical oversight in the development of transitional care policies, procedures, and programs and their implementation across all OSH regions 

    • Provide clinical direction and guidance to transitional care management team (RN, LCSW, etc.)

    • Offer peer-to-peer discussions with internal clinical team members

    • Lead regional inpatient and skilled nursing discharge planning rounds

    • Engage directly with inpatient and post-acute physicians and medical directors to facilitate safe and timely discharge, appropriate follow-up care, and next steps

  • Utilization Management:

    • Partner with operational dyad leader to define UM goals, KPIs, and program strategy

    • Directly manage and supervise team of physician UM reviewers

    • Oversee quality oversight of clinical review (includes quality audit and IRR)

    • Intervene and support the management and decisioning of complex cases

    • Active and working knowledge of MCG guidelines for clinical review and determinations

    • On-call shift coverage for clinical review, i.e., utilization reviews and peer-to-peer discussions with requesting providers

    • Manage grievances and appeals related to clinical determinations

    • Serve as key clinical liaison to resolve concerns or issues raised by health plan partners or downstream vendors/delegates

  • Clinical Leadership:

    • Design cost of care, transitional care, and UM components of new provider onboarding

    • Serve as peer mentor to field-based medical directors, clinical leaders and clinical UM staff

    • Engage with Executive Medical Leadership on key clinical priorities and cost of care strategy

    • Champion and advocate transitional care and UM programs/innovation to gain buy-in with key stakeholders and accelerate program implementation

    • Support Finance and Medical Economics to identify and resolve payment integrity concerns

  • Cross-Team Collaboration:

    • Partner with key corporate teams, including Finance, Managed Care Operations, Clinical Services, Data, and Product

    • Drive awareness of Transitions and UM Programs across the organization and advocate for deeper integration with center-based care

  • Facility / Vendor Relationships

    • Build preferred relationships with facilities and vendors that support positive patient outcomes, including inpatient facilities, post-acute facilities, home health vendors, speciality review, etc.

    • Partner with regional clinical leaders to cultivate relationships with key clinical leaders at high-priority partner organizations (e.g., CEO, CMO, CNO, etc.)

    • Develop preferred facility/vendor relationship playbook that can be leveraged by regional clinical leaders

  • Health Plan Delegation / CMS Requirements

    • Lead Medical Management Committee

    • Attend Joint Operating Committee meetings

    • Serve as internal subject matter expert on CMS guideline changes and updates with particular emphasis on guidance regarding transitional care and utilization review

    • Support sales and contracting discussions with plan partners to increase reach of OSH delegated programs

  • Key Performance Indicators

    • Utilization across (in order of priority & impactability) relative to Milliman Well Managed benchmarks:

      • SNF: ALOS, Direct RTA, 30D RTA, BDK, ADK

      • ED/Obs: Obs/Admits, EDK, Obs/K, 

      • Acute: ED Admits/K, 30D Readmission Rate, ADK

    • Third-party medical costs (total and PMPM) specific to emergency, inpatient and post-acute utilization

    • Overturn rate

  • Other duties as assigned

What are we looking for?

  • Passionate about their work and motivated to be a part of a fast growing organization

  • M.D. or D.O. 

  • Board certified

  • Other professional degrees (e.g., M.B.A., J.D., M.P.H.) welcome but not required

  • Minimum of 5 years of experience in clinical practice

  • Minimum of 3 years of experience in physician management or medical director role

  • Experience with Utilization Management and clinical review/decision making of prior authorizations

  • Experience in clinical leadership roles, leading and coaching physicians to be the best they can be for their patients and their colleagues

  • Experience using a metrics-driven approach to analyze cost, quality, and satisfaction data to drive clinical strategy and program redesign

  • Understand the basics of managed care and recognize that population health and a focus on smart allocation of scarce resources can lead to high value care (better care, lower cost)

  • Ability to collaborate effectively with staff, providers, and a diverse group of leaders

  • US work authorization

  • Someone who embodies being “Oaky”

What does being “Oaky” look like?

  • Radiating positive energy

  • Assuming good intentions

  • Creating an unmatched patient experience

  • Driving clinical excellence

  • Taking ownership and delivering results

  • Being scrappy

Why Oak Street?


Oak Street Health offers our coworkers the opportunity to be at the forefront of a revolution in healthcare, as well as:

  • Collaborative and energetic culture

  • Fast-paced and innovative environment

  • Competitive benefits including paid vacation and sick time, generous 401K match with immediate vesting, and health benefits

Oak Street Health is an equal opportunity employer. We embrace diversity and encourage all interested readers to apply to oakstreethealth.com/careers.

Oak Street Health

Address

Gary, IN
46408 USA

Industry

Healthcare

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