Responsibilities

• Develop policies and procedures for Utilization Management, Care Management and Disease Management Programs utilized by IPA Providers for individuals receiving skilled nursing and/or long-term care services in the home so as to achieve appropriate cost-effective, high quality patient care.
• Develop clinical pathways with respect to the IPA s remote patient monitoring program to achieve best practices and positive health outcomes and to reduce inappropriate emergency department and urgent care utilization.
• Oversee Care Management and Disease Management Program implementation and interface with IPA providers and other staff for medical advice and intervention as needed.
• Monitor IPA provider utilization and trends and communicate program outcomes to IPA leadership and make recommendations to IPA leadership proactively to manage trends effectively.
• Collaborate with leadership on incentives, metrics, clinical programs, and training that will improve the quality of care provided to members along with decreasing costs.
• Assess IPA provider network for adequacy of services and make recommendations to IPA leadership to address service gaps.
• Develop educational programs for IPA providers and provide education, guidance, and feedback to IPA providers with respect to compliance with Utilization Management, Care Management and Disease Management policies and procedures.
• Assess the adequacy of information being provided by the IPA-to-IPA providers and assist in development of any new or revised materials.
• Serve as the main point of contact for IPA providers who wish to speak directly about clinical pathways and best practices.
• Participate in appropriate committees to support performance improvement, improve quality of care and provider and patient.

Qualifications

• Valid NYS medical license
• 3+ years of clinical practice in emergency medicine, geriatrics, or other relevant direct patient care experience.
• Past experience in Medical Management preferred.