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Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.

Position Summary

The VP Medical Director of Clinical Programs will manage the Health Plan Medical Directors and, as a Medical Director team, provide clinical support for the Health Management Utilization Management, Care Management and Quality teams. This VP will drive the development, promotion and delivery of high quality, evidence-based utilization and care management programs and processes. The VP will lead programs and reviews to support effective medical expense management, medical quality programs and outcomes, and programs to manage medical utilization trends such as inpatient, Emergency Department, Site of Care, pharmacy and radiology.

Job Description

PRIMARY DUTIES AND RESPONSIBILITIES

+ Identify and list the top 8 to 10 Essential Functions for the position.

+ Essential functions are:

+ Fundamental job duties

+ Considered a critical component of the role

+ Required for an employee to perform, with or without reasonable accommodation, to be considered for the role.

+ The Essential functions are written as an outcome-focused statement describing the responsibility.

+ For example, rather than saying “Develops department budget”, an outcome-focused statement would say, “develops department budget that is consistent with industry benchmarks to support MPHC strategic goals”.

+ Key Outcomes are stated at a high level to allow flexibility in how the outcome is met from year to year.

+ Do not outline every task performed, list only the essential functions.

+ Employees will be expected to perform other duties from time to time even if they are not outlined in the job description.

+ The job descriptions focus employees on expected outcomes rather than the daily tasks they are performing.

+ Factors to consider in determining if a key outcome is essential include:

+ Is the reason the position exists to perform that function?

+ Can someone in a different role perform the function or is it unique to this role?

+ The degree of expertise or skill required to perform the function.

Establishing the essential functions is critical in the following ways:

+ Identifying what functions the employee will be performing

+ Determining ADA Accommodation

+ Identifying qualified candidates during recruitment process

+ Determining if an employee can safely return from leave of absence

Employees are expected to work consistently to demonstrate the mission, vision, and core values of the organization.

+ Achieves defined clinical outcomes, affordability goals and growth targets, in partnership with HP SLT, to accomplish HP strategy, quality and cost containment

+ Works closely across the HP to ensure compliance with government program regulations, including management of clinical appeals and grievances with sound clinical evidence and advice

+ Works closely with the Medical Directors and the Director of Medical Economics to devise analytic approaches that support and measure strategic development and sound clinical programs

+ Provides clinical insight into data to assist in development of and measurement of tailored interventions that address clinical trends and opportunities

+ Develops key strategies to address opportunities in medical expense management

+ Identifies opportunities for improvement in the quality of care that create competitive advantage for Martin’s Point as it relates to the health of populations served

+ Accountable for appropriate Utilization Management processes including sound partnership and collaboration between the UM/CM team and the Medical Directors to ensure High performance of team members that drive the right services at the right place and time for our health plan members

+ Assists and provides clinical input into the evolution of care/utilization management, quality, and pharmacy related programs

+ Contributes to and advises in product design and the Medicare bid processes

+ Contributes to and advises in areas of clinical integration as it relates to risk adjustment

+ Serves as a central HP leader aligning medical, clinical, and operational functions to achieve seamless and thorough solutions related to Medical and Payment Policies

+ Actively engages with quality, network, and compliance teams to help drive performance

+ In collaboration with the MPHC Chief Medical Officer (CMO), advocates with government/state regulatory entities, professional and medical society chapters, federal regulators/contactors, and as part of external communications and media relations to advance HP’s clinical value story, evidence-based medical policies, and member health

+ Provides subject/specialty-based clinical expertise and leadership to Clinical Programs and other areas of MHPC, as needed

+ Assists the Market Medical Director for building and deepening relationships with area hospitals, physicians, and other health care providers in support of the Quadruple Aim

+ Assists in creating a cohesive, network engagement strategy and reporting capability that supports iterative improvements in performance to population health and care management goals that are specifically tied to contractual agreements

We are an equal opportunity/affirmative action employer.

Do you have a question about careers at Martin’s Point Health Care? Contact us at: [email protected]