Medical Director - MetroPlusHealth : Job Details

Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. About NYC Health Hospitals MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health Hospitals, the largest public health system in the United States, MetroPlus Health 's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus Health has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life. Position Overview Under the supervision of the Chief Medical Officer, the Medical Director for the Partnership in Care Department will have direct responsibility for the MetroPlusHealth HIV Special Needs Plan (Partnership in Care Program) and the care management of all other MetroPlus Health members living with HIV. The Medical Director will assure continued program development of the HIV Special Needs Plan by providing direct clinical support for all clinical activities, as well as support and interaction with the overall plan's Utilization Management, Quality Management, Finance, Member Services and Enrollment divisions. Job Description Develops and articulates the vision and strategic direction for the entire Partnership in Care Department; collaborates on the implementation of evidence-based strategies for ending the HIV epidemic and ensuring high quality care to all members with HIV. Directs oversight of the plan's HIV Special Needs Plan (Partnership in Care) and the care management of all other MetroPlusHealth members living with HIV. Develops, implements, and annual reviews the HIV SNP's comprehensive Quality Management/Quality Improvement Plan. Ensures compliance with Federal, State and City regulations as they relate to the HIV SNP and HIV Services. Conducts Program oversight and coordination of all aspects of the HIV Special Needs Plans with reporting quarterly to the Quality Assurance Committee of the Board of Directors. Promotes and facilitates a multidisciplinary approach to patient care and coordination of care among disciplines; ensures that patient care delivery models and standards of HIV services provision are consistent with current professional standards and with the mission, vision, and values of the organization. Provides excellent customer service at all times to internal and external customers. Develops and manages the budget for the Partnership in Care department. Directs the determination of fiscal requirements of assigned programs and reviews budgetary recommendations; monitors and controls the expenditure of budgeted funds. Interacts with other departments responsible for functional aspects of the HIV Special Needs Plan including Quality Management, Utilization Management, Marketing, Eligibility, Customer Services and Finance. Represents the health plan at regulatory committees including the New York State AIDS Institute SNP Quality Committees, and others that are scheduled. Represents the health plan at regulatory meetings held by the New York City Department of Health and Mental Hygiene and managed care trade organizational meetings as necessary. Provides clinical support for the review of quality-of-care concerns being investigated by the Quality Management Department. Reviews and assesses provider and facility utilization patterns and provides appropriate education and feedback to outliers and others that would benefit from plan input. Proposes modification of existing plan programs and processes, or other outreach or education necessary based on the review of utilization, quality, and financial reports. Works as part of the Medical Management Medical Directors Team which supports utilization management for all lines of business, including review of denials and some appeals. Oversees a grant-funded outreach team involved in returning members to care in collaboration with a community-based organization. Minimum Qualifications A Doctor of Medicine or Doctor of Osteopathic Medicine degree from an accredited and approved school of medicine A minimum of three years clinical experience A minimum of two years administrative experience with supervision of staff Experience and knowledge in Care, Case, and Disease Management Licensure and/or Certification Required Requires valid and current license to practice medicine in the state of New York Must complete at least 10 hours of annual CME training in areas of HIV care Board Certified or Board Eligible in a Primary Care Specialty, with either an infectious diseases fellowship or special training in the care and treatment of patients with HIV The Physician must meet the qualification of an HIV Specialist as defined by the NYSDOH AIDS Institute Professional Competencies Integrity and Trust Customer Focus Functional/Technical skills Written/Oral Communication Excellent communication, written, presentation and analytical skills LI-Hybrid