Network Control Center Director jobs in California

Organizational Description

The Community Health Center Network (CHCN), sister organization to the Alameda Health Consortium, is made up of the eight federally qualified community health centers in Alameda County. CHCN functions as the managed care services organization (MSO) for our health centers, contracting with the Alameda Alliance for Health. In order to help our health centers meet their missions of providing the best possible care to their communities, we also provide a broad range of training, technical assistance, quality improvement, information technology, and data analytic services.

Position Title: Per Diem Medical Director

Department: Clinical Department

Reports To: Chief Medical Officer

Classification: Non-Exempt

Status: Per Diem

POSITION SUMMARY

The Per Diem Medical Director (PDMD) is a member of the medical team, focused on utilization management (UM), reviewing authorization requests for services provided to members in our network. Depending upon experience, availability and need, the PDMD may provide care management, quality improvement, quality assurance review. They join a team of medical officers taking weekend call and evening support as available.

They support the outpatient team with UM reviews, referrals for basic case management, and consulting on complex authorizations for medical necessity. For the inpatient team, they consult with UM nurses on the medical necessity of concurrent review, support the care management plan of patients, and assist with discharge planning as needed.

For both teams, the PDMD integrates quality improvement efforts based on regulatory needs and internal efficiency efforts. The position is fully remote.

ESSENTIAL POSITION RESULTS

The essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks and responsibilities. Employees may perform other duties as assigned. As a per diem position, the PDMD works as a team with the CMO and medical director for the responsibilities below based on available time and need.

• 
  Shares responsibility for the utilization management for inpatient care, determining medical necessity, interpreting benefits and limitations, consulting with providers and supporting the inpatient nurse team in their concurrent review of hospitalized members. May lead weekly clinical rounds with CHCN nurses and health plan guests.
• Shares responsibility for members requiring transitions of clinical services in specialty programs and populations such as California Childrens Services (CCS).
• Shares responsibility for utilization management decisions for outpatient care: determining medical necessity, interpreting benefits and limitations, and consulting with providers.
• Provides clinical advice and support to the Care Neighborhood program team, supporting high risk and vulnerable populations with post-discharge care planning.
• Attends CHCN’s monthly medical officer meetings for trainings and policy updates.
• Attends regular senior leadership meetings with health plans, as needed.
• Able to work weekends and evenings when on call and respond in a timely manner.
• Other duties as assigned.

SUPERVISORY RESPONSIBILITIES

None.

MINIMUM QUALIFICATIONS

Competencies

• Leadership skills and experience
• Sound clinical judgment and ability to evaluate evidence and guidelines around medical treatments
• Excellent communication skills and ability to work well with a team
• Computer literacy, especially as it involves synthesis of patient care information
• Ability to develop new policies and procedures, training nurses or providers on new skills
• Commitment to underserved populations
• Exceptional time management and prioritization skills
• Ability to understand the broader healthcare landscape while being attentive to project details
• Supportive of managed care philosophy
• Able to manage difficult conversations with professional peers related to medical case review

Education & Experience

• Active, unrestricted, California medical license and MD/DO from an accredited program in Internal Medicine or Family Medicine. Board certification preferred
• 2 years clinical experience, preferably with hospital and primary care experience
• 2 years managed care and utilization management experience strongly preferred, including familiarity with Milliman Care Guidelines
• 2 years working on a team involved with clinical management, preferably in a leadership role

General CHCN Roles

• Fosters an environment that promotes trust and cooperation among clients and staff
• Enforces policies and procedures, including maintenance of client confidentiality, to ensure that the principles of CHCN are implemented
• Accountable for participating in decision making processes and understanding the outcome(s)
• Understands the values and principles of CHCN and applies them in work responsibilities
• Participates in outreach activities, agency advocacy, and serves on ad hoc committees, as requested
• Attends CHCN and Board of Directors meetings, as required

CERTIFICATES AND/OR LICENSES

• 
  Licensed with the Medical Board of California
• Board certification

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to sit and use hands to finger, handle, or feel. The employee is frequently required to talk or hear. The employee is frequently required to stand; walk; reach with hands and arms and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 15 pounds. Specific vision abilities required by this job include close vision and ability to adjust focus.

WORKING CONDITIONS AND ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly exposed to an inside environment.

The Community Health Center Network is an Equal Opportunity Employer.