Medical Clinical Director

POSITION SUMMARY The Medical Director is responsible for the delivery of participant care, clinical outcomes, and the implementation, as well as oversight, of the quality assessment and performance improvement (QAPI) program. The Medical Director serves as the lead in the design of the medical and clinical components and as a liaison to the medical community. As a physician member of the team, the Medical Director must meet all federal and state licensing laws, certification, and regulations necessary. The Medical Director serves as the consultant and resource to the Primary Care Physician, on‑call physicians, and Nurse Practitioners. The Medical Director also interfaces and collaborates with specialist physicians in the provider network. Note : All employees responsible for patient care must be competent in the assessment, treatment, and age‑related care of geriatric patients. Consequently, employees must be competent in the interpretation of a patient’s self‑report or behavior, and this information must be interpreted with an understanding of the cognitive, physical, emotional/psychological, and chronological maturation process. The treatment of patients should be individualized and reflect an understanding of the developmental needs and range of treatment needs for each patient. ESSENTIAL FUNCTIONS OF THE JOB RESPONSIBLE TO Executive Director and Chief Medical Officer RESPONSIBLE FOR Geriatrician, PCPs, Nurse Practitioners, Medical Assistants, Pharmacist, Pharmacy Technician DUTIES AND RESPONSIBILITIES QUALITY ASSESSMENT AND PERFORMANCE IMPROVEMENT Provides leadership in quality improvement program through participation on the Quality of Care Committee; Understands the regulations related to QAPI and the Medical Director’s role; Proactively develops a collaborative working relationship with the Quality Coordinator and contributes to the development of the QAPI plan; Oversees the delivery of participant care (resources), clinical outcomes, performance improvement, and Utilization Management (UM); Designs and conducts quality projects and stays abreast of federal Outcomes‑Based Quality Improvement initiatives; Conducts clinical research and quality studies related to participants and services; Participates in Quality Improvement Committee meetings; Responsible for the implementation, as well as oversight, of the QAPI program. CONTINUUM OF CARE Defines, develops, and implements the system of 24‑hour medical coverage; Works with administrative leaders to ensure that contracts with network providers are fair, clinically appropriate, and financially prudent; Assembles a panel of network specialist consultants while meeting key regulatory, clinical, and administrative protocols; Liaises with physician groups, specialists, and hospitals to strengthen positive provider relationships and enhance referrals; Plays a critical role in educating the medical and aging communities about the role of the program in the long‑term care continuum; Interfaces with contracted medical providers when quality concerns arise; Participates in contract negotiations with medical providers; Promotes the mission and goals of the program in the neighborhood, in the community, to referral and regulatory agencies, and other stakeholders; Acts as liaison with county physicians; Plays a vital collaborative role in marketing, intake, and enrollment. CARE DELIVERY/INTERDISCIPLINARY TEAM Provides input into cost‑effective clinical practices; Integrates Frail & End‑of‑Life Care Clinical Glidepath Tools and Best Clinical Practices into ongoing primary care service and support; Provides orientation, education, and ongoing training of new PCPs and Nurse Practitioners (NPs); Defines the NP collaborative practice arrangement, including scope of practice, prescriptive authority, and autonomy; Consults on the development of clinical policies and procedures; Coordinates the performance appraisal of primary care physicians, nurse practitioners, and consulting pharmacists; Provides medical consultation to staff; Develops policies and procedures for patient care based on evidence‑based medicine protocols and best practices in geriatric medicine; Responsible for the delivery of participant care and clinical outcomes; Evaluates and implements clinical geriatric practice guidelines based on current literature and shared state‑of‑the‑art clinical information; Participates in Multidisciplinary Team meetings; Serves as a member of the management team; Provides direct medical care when the team physician is unavailable; Oversees palliative and end‑of‑life care, focusing on the best possible quality of life through relief of suffering, control of symptoms, and restoration of functional capacity while remaining sensitive to participant personal, cultural, and religious values. CLINICAL COMPLIANCE Serves as a physician liaison to state and federal agencies, as requested; Ensures compliance with provider regulations as they pertain to medical/clinical and geriatric components of care; Oversees the clinical, compliance, and documentation dimensions of the comprehensive Medical Record system and process; Ensures optimal design of the Medical Record system to address interdisciplinary team communications, optimal diagnostic coding, and clear documentation for medico‑legal risks, as well as standards for QAPI and research initiatives; Participates in complaint and grievance procedures when issues involve medical or clinical care; Works with other leaders to guide the successful collection, submission, and analysis of diagnostic risk adjustment data; Reviews coding and demographic files to ensure specificity of data and optimize individual capitation payments; Chairs the Medical Advisory Committee and the Ethics Committee, advising the Board of Directors; Administers the Medical Director’s role in a manner consistent with core values and mission; Monitors unusual occurrence reports to ensure participant health and safety; Investigates all Level Two Events and translates findings into opportunities to improve clinical care; Develops policies and procedures for appointment of medical staff and review of clinical privileges. PRESCRIPTION DRUG PLAN (MEDICATION MANAGEMENT) Collaborates with the pharmacist to oversee the clinical aspects of the Medication Management Process, including prescriptions, dispensing, and administration of medications; Designs a formulary using geriatric medication and cost efficacy guidelines, if specified and clinically necessary; Develops prescription criteria addressing clinical risks, comorbidities, polypharmacy risks, limited life expectancy, frailty, and vulnerability to adverse drug reactions (ADRs); Works closely with the consulting pharmacist to monitor pharmacy utilization and medication prescribing patterns to avoid ADRs and polypharmacy risks. PATIENT‑CENTERED MEDICAL HOME Sponsors and promotes the design, organization, and operation of the primary care clinic as a Patient‑Centered Medical Home (PCMH) Model of Care.; Defines the scope of primary care practice and clinical activities in the PCMH.; Champions improvements and operation of the Electronic Medical Record (EMR) system for the primary care clinic and eldercare continuum.; Implements in‑home electronic technology monitoring of participants (telehealth, vital signs monitoring, remote patient monitoring, fall detection, etc.). ADDITIONAL DUTIES AND RESPONSIBILITIES Provides in‑service education to staff, as requested.; Sustains an organizational commitment to diversity of staff and the skills needed to serve a diverse population.; Oversees educational rotations for medical students, residents, nursing students, social workers, pharmacists, public health students, and rehabilitative specialists.; Performs other duties as assigned. QUALIFICATIONS Education M.D. degree and licensure to practice medicine and surgery in the State of California.; Board certified in internal medicine or family practice.; Certificate of added qualification in geriatrics and/or experience in the care of the chronically ill.; Fellowship in Geriatrics preferred. Experience Minimum of three years in medical practice for the chronic care geriatric population.; Demonstrates skills in medical administration and/or previous experience as a Medical Director.; Experience working with an interdisciplinary team and performing comprehensive geriatric assessments preferred.; A record of forming and implementing a vision for an organization. Knowledge, Skills, and Abilities Current knowledge of chronic care/geriatric issues and best practices.; Solid “fit” with the culture and mission; while Geriatric training and experience are helpful, the “fit” with the culture is more important.; Skill to build strong working relationships with physicians and other health care providers.; Good judgment, problem‑solving, and cognitive skills.; Ability to process information accurately and in a timely manner.; Ability to coordinate and facilitate teamwork and interdisciplinary groups.; Good public communication skills.; Demonstrated leadership abilities.; Enthusiasm for geriatric medicine and caring for the chronically ill. KEY WORKING RELATIONSHIPS The primary contacts for the Medical Director are the Executive Director, Chief Medical Officer, Primary Care Physician, Nurse Practitioner, and other members of the leadership team. External contacts include extensive interaction with representatives of the medical community, long‑term care providers, and assisted living providers. PERFORMANCE MEASURES & STANDARDS Supervises all medical/paramedical services to achieve the best clinical outcomes (20%); Achieves Patient‑Centered Medical Home (PCMH) objectives (10%); Attains Medication Management goals (10%); Oversees the QAPI program, including development and reporting (20%); Maintains and improves medical policies/standards (10%); Develops and implements a system of peer review (10%); Enhances the Continuum of Care through 24‑hour medical coverage (15%); Provides information about the program to interested individuals (5%). CONDITIONS OF EMPLOYMENT T.B. and physical clearance; current First Aid and CPR; fingerprint clearance; must have reliable private vehicle, proof of CA driver’s license, and current vehicle insurance. Be medically cleared for communicable diseases and have all immunizations up‑to‑date before engaging in direct participant contact. UNIVERSAL REQUIREMENTS Pre‑employment requirements include I‑9, physical, positive background and reference check results, complete application, new hire orientation, pre‑employment PPDs. HIPAA/Compliance: Maintain privacy of all patient, employee, and volunteer information. OSHA Compliance: Comply with all regulations and required schedules regarding OSHA training. PPD Compliance: Required health screening to be performed annually. Policies and Procedures Compliance: Responsible for following all policies and procedures. Sexual Harassment Training: Comply with all regulations regarding sexual harassment training. #J-18808-Ljbffr