Director UM Management Nurse

AVP, Medical Director - Utilization Management page is loaded## AVP, Medical Director - Utilization Managementlocations: US - Remotetime type: Full timeposted on: Posted Todayjob requisition id: M103138**Job Description Summary**We are seeking a dynamic, board-certified physician to serve as the Medical Director for our rapidly growing Florida (statewide) house calls program. This pivotal role combines direct patient care with executive clinical leadership. You will work alongside the Director of Florida House calls, in a dyad model, to oversee a dedicated team of Advanced Practice Registered Nurses (APRNs) across Florida, ensuring the delivery of high-quality, value-based care to frail geriatric populations within the comfort of their homes. The ideal candidate is a visionary clinician with a deep understanding of the complexities of geriatric and palliative care, possessing the administrative acumen to scale clinical operations while maintaining rigorous quality standards.**How will you make an impact & Requirements****Location:** Florida (Statewide Coverage)**Position Type:** Full-Time (Hybrid: 3 Days Clinical / 2 Days Administrative)**Reporting To:** Florida CMO**Key Responsibilities*** Clinical Leadership & Administrative Oversight (2 Days/Week)* Direct Patient Care (House Calls 3 Days/Week)* Team Supervision: Work as a dyad with the Director of House calls to provide direct clinical support, mentorship, and oversight to a statewide team of APRNs.* Quality Management: Monitor, and maintain clinical quality benchmarks and KPIs to ensure excellence in patient outcomes.* Value-Based Care Strategy: Maintain focus on value-based outcomes, reducing hospital readmissions, and managing the total cost of care for the frail elderly.* Regulatory Compliance: Serve as the primary physician of record for regulatory requirements, providing essential backup for prescribing controlled substances and ensuring adherence to Florida state laws.* Auditing & Training: Conduct regular clinical audits and deliver ongoing medical education/training to providers to ensure standardized, evidence-based practice across the state.* Complex Case Consultation: Act as the final clinical authority and guide for complex patient cases in palliative and geriatric care.* House Calls: Conduct in-home clinical visits three days per week, providing comprehensive primary, geriatric, or palliative care to a designated patient panel.* Clinical Excellence: Demonstrate "lead by example" clinical practices, maintaining high patient satisfaction and thorough documentation within the EMR.* The Associate Medical Director of House Calls will report up to the MPG Chief of Geriatrics.**Qualifications & Requirements*** Education: Medical Degree (MD or DO) from an accredited institution.* Board Certification: Current Board Certification in Geriatric Medicine or Hospice and Palliative Medicine is highly preferred. Internal Medicine or Family Medicine with extensive geriatric experience will be considered.* Licensure: Unrestricted Florida Medical License and valid DEA registration.**Experience:**Minimum of 3 years of clinical practice, specifically caring for geriatric or frail populations.Deep functional knowledge of Value-Based Care (VBC) models, Medicare Advantage, and risk-adjustment coding (HCC).**Skills:*** Strong interpersonal skills with a focus on collaborative leadership with Advanced Practice Providers.* Ability to travel across the Florida region as needed for clinical days and provider training.* Proficiency in clinical informatics and utilizing data to drive quality improvements.Mosaic Health is a national care delivery platform focused on expanding access to comprehensive primary care for consumers with coverage across Commercial, Individual Exchange, Medicare, and Medicaid health plans. The Business Units which comprise Mosaic Health are multi-payer and serve nearly one million consumers across 19 states, providing them with access to high quality primary care, integrated care teams, personalized navigation, expanded digital access, and specialized services for higher-need populations. Through Mosaic Health, health plans and employers have an even stronger care provider partner that delivers affordability and superior experiences for their members and employees, including value-based primary care capacity integrated with digital patient engagement and navigation. Each of the companies within Mosaic Health provide unique offerings that together promise to improve individuals' health and wellbeing, while helping care providers deliver higher quality care. For more information, please visit Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.If you require an accommodation for the application or interview process, please let us know and we will work with you to meet your needs. Please contact View email address on click.appcast.io for assistance. #J-18808-Ljbffr Mosaic Health, LLC.