Regional Medical Director Massachusetts

Job Summary The Regional Medical Director serves as the clinical leader within the geographic region, driving clinical outcomes, affordability, decreased total cost of care, the delivery of value-based care, and population health management across the care centers. This role encompasses leading transitional care teams, establishing relationships and communication pathways with hospital leaders and health systems, cultivating a sub-specialty network, and overseeing multidisciplinary teams of healthcare providers to ensure integrated and comprehensive patient care within the region. Oversight of clinical, utilization management, and financial total cost of care outcomes for total members attributed to AbsoluteCare, whether we are the members' primary care provider. Facilitating and leading discussions with providers regarding appropriate care, utilization, and care coordination. This includes inpatient, emergency departments, 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 Duties and Responsibilities Clinical Leadership and Oversight: Oversee clinical operations across multiple Care Centers within the assigned region. 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 across the geographic region, 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 ~10-30% of the physician leaders time, in the form of caring for a small panel of the market's 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 across the region 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: Represent AbsoluteCare in regional healthcare forums and community meetings. 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: Develop and implement regional strategies 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. 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, hospital physician advisor, or board certification in addiction medicine, infectious disease a plus BLS certification required. 2-5 years' experience in a leadership position with 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. Knowledge and experience using Electronic Medical Records and ability to analyze and leverage their reporting capabilities. Working knowledge of Microsoft Office Suite (Word, Outlook, PowerPoint, and Excel). #J-18808-Ljbffr Assocmedpsych