Medical Director Complex Care

AbsoluteCare is seeking a dynamic physician leader to put the principles of population health into action for our medically complex & socially vulnerable members. Oftentimes, due to the effects of trauma and poverty, a significant portion of our population suffer from infectious diseases – including HIV, Hepatitis C, and complex wound infections. Through our integrated care teams, including physicians, advanced practice practitioners, nurse care managers, social workers, behavioral health therapists, peer counselors, dietitians, pharmacists, and community outreach workers, we transform the lives of our members.

Working within our matrix organization, the Medical Director will collaborate closely with the National Directors of their respective disciplines to implement process improvements, enhance our standards of care, and surpass discipline specific professional practice guidelines in our ambulatory intensive caring unit care model. As a dyad partner with the Practice Administrator, the Medical Director will be responsible for all the medical center outcomes including utilization, quality outcomes and the overall operation of the medical center and providers. This role is instrumental to our fast-growing organization’s success, and requires a person who exhibits dynamism, humility, clinical acumen, the ability to work collaboratively, and strong leadership skills.

Job Summary:

• The Medical Director serves as the clinical leader within the market, driving clinical outcomes, affordability, decreased total cost of care, the delivery of value-based care, and population health management. This role encompasses leading a transitional care team, establishing relationships and communication pathways with hospital leaders and health systems, cultivating a sub-specialty network, and overseeing a multidisciplinary team of healthcare providers to ensure integrated and comprehensive patient care.
• Oversight of clinical, utilization management, and financial total cost of care outcomes for total members attributed to AbsoluteCare; whether member chooses AbsoluteCare as primary care provider or not.
  • Facilitating and leading discussions with AbsoluteCare and Non-AbsoluteCare providers regarding appropriate care, utilization, and care coordination. This includes inpatient, emergency department, skilled nursing facilities, specialists, other primary care providers, home nursing and other providers within the healthcare ecosystem.
  • Special attention to reduction of Admissions/1000, Readmissions/1000, ED Visits/1000, and SNF days/1000

Key Responsibilities:

• Clinical Leadership and Oversight: Serve as the clinical leader for a team, including physicians, Advanced Practice Providers (APPs), and behavioral health consultants, focusing on integrated and holistic approaches to reduce unnecessary utilization and improve patient outcomes. Responsible for clinical oversight, care coordination, and outcomes for all members attributed to AbsoluteCare; primary care and community based members (non-PCP).
• Direct Care Delivery: Provide direct clinical care ~30% of the physician leaders time, in the form of caring for a small panel of the markets highest utilizers, covering for full time providers as needed, and providing care in our immediate care area (same day, walk in, acute care, and hospital follow up for community members).
• Community based Non-PCP member oversight and care coordination: understanding and appropriately influencing care occurring outside of AbsoluteCare’s centers. Individual members and at the population level.
• Transitional Care Management: Lead the development and implementation of effective transitional care plans for all members attributed to AbsoluteCare (PCP or not) to ensure seamless patient transitions across different care settings. Accompany, train and mentor Transitional and Complex Care Managers in hospitals, Skilled Nursing Facilities and homes. This includes spending valuable time rounding in hospitals, skilled nursing, or other facilities – engaging members, building strong relationships and discussing cases with hospital/facility teams to drive the goals of transitional care:
  • Member engagement
  • Appropriate length of stay
  • Readmission reduction
• Network and Relationship Building: Develop and maintain relationships with hospital leaders, health systems, community based providers, and health plan care and utilization management teams to enhance coordination, clinical outcomes, appropriate utilization, and quality of care.
• Sub-Specialty Network Development: Spearhead the cultivation of a sub-specialty network that supports in integrated, high value specialized care for patients including home health.
• Quality Metrics and Patient Safety: Focus on achieving superior performance in HEDIS quality metrics, clinical coding documentation excellence, patient safety, engagement, and satisfaction.
• Strategic Initiatives: Implement strategic medical operations and protocols aimed at achieving the organization's value-based clinical and financial total cost of care goals.
• Team Leadership: Provide guidance and leadership to medical staff, fostering a collaborative environment that encourages innovation and continuous improvement.

Minimum Qualifications:

• Licensed physician in the state of practice, board-certified in Internal Medicine, Family Practice, or Emergency Medicine.
  • Experience as a hospitalist, caring for inpatients, hospital operations, or hospital physician advisor a plus
• BLS certification required.
• Proven experience and passion for value-based care including total cost of care models:
  • Experience successfully managing utilization – with focus on Admissions, Readmissions, ED visits, SNF Days per 1000
  • Experience with and proven knowledge of HEDIS and Medicare Stars measures
  • Experience with Milliman Care Guidelines or health plan operations (Medicaid, Dual, and/or Medicare Advantage a plus)
• Knowledge and experience – population health management with vulnerable, complex Medicaid, Dual, and/or Medicare Advantage populations
• Demonstrated ability to lead multidisciplinary teams and manage vulnerable, complex patient populations with multiple adverse social determinants of health.
• Excellent clinical skills with a strong focus on quality metrics and population health management.
• Experience with Electronic Medical Records and data-driven decision-making.

Working Conditions: This role operates in both a clinical and administrative environment. There may be potential exposure to blood, bodily fluids, and infectious materials. Use of standard office equipment and occasional travel between facilities is required.

Physical Requirements: Must be able to communicate effectively and remain stationary or move about for prolonged periods.

Approval and Review: This job description is subject to change and may be reviewed and revised by management at any time.