Corporate Medical Director (VP)
As one of the nation’s largest not-for-profit Medicare Advantage plans, serving more than 200,000 members in California, SCAN Health Plan has been a mission-driven organization dedicated to keeping seniors healthy and independent for over 40 years. SCAN employees are passionate about what they do, and understand that success is based on achieving the mission. Employees are afforded with the training and tools necessary to do their jobs and are rewarded for their efforts and recognized as experts in their fields. To learn more, visit scanhealthplan.com or follow us on social media: LinkedIn; Facebook; and Twitter.
With a focus on delivering comprehensive, high quality person-centered care across the health care continuum, the Corporate Medical Director will work closely with SCAN healthcare leadership and provide leadership to the Medical Policy and healthcare services care management teams to develop and promote strategies and policies that enhance the delivery of the quadruple aim. This position is a corporate position located in Southern California, supporting both Northern and Southern California Health Plan clinical operations and serves as the first point of contact for SCAN’s internal clinical teams pertaining to medical management, medical policy, and quality programs.
- Oversee SCAN’s medical policy team with a focus on developing and implementing Medicare medical policy, including recommendations for modifications to improve efficiency and effectiveness. Develop policies to cover SCAN’s supplemental benefits.
- Provide clinical oversight and leadership of corporate activities like grievance and appeals.
- Provide direction and act as a resource to the Multidisciplinary team to discuss individual member care management gaps, interventions and collaboration with Providers and Specialists.
- Engages in peer to peer discussion with the Medical Directors of our contracted medical groups regarding care management interventions and strategies for high risk/high cost patients.
- Support and oversee the medical management of high risk/high cost members to achieve the quadruple aim as the medical leader of the multidisciplinary team.
- Act as the clinical liaison to the Chief Medical Officer, providers and facilities to support the effective execution of medical management services and programs.
- Lead and direct the outcome of the patient care conferences and case rounds.
- Provide medical leadership for case management and medical quality improvement activities.
- Participate in the development of evidence based case management and clinical guidelines for comprehensive healthcare programs such as disease management, complex care management, etc.
- Support effective implementation of performance improvement initiatives with a focus on 5 star quality improvement for provider partners.
- Assist Chief Medical Officer in planning and establishing goals and policies that improve quality and cost-effectiveness of care and service to members.
- Provide leadership and participate in key clinical committees like P & T, Credentialing, Peer review and other quality management committees.
- Provide medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.
- Assist the Chief Medical Officer in the functioning of the physician committees including committee structure, processes, and membership.
- Assist in the development and implementation of physician education with respect to clinical issues and policies.
- Identify clinical quality improvement studies to aid the reduction of unwarranted variation in clinical practice and improve the quality and cost of care.
- Review claims involving complex, controversial, and/or unusual or new services in order to determine medical necessity and appropriate payment.
- Develop alliances with the provider community through the development and implementation of medical management programs.
- Support clinical programs offering services to community-based seniors through Independence at Home.
- Contribute to team effort by identifying and achieving goals/targets as needed.
- Actively supports the achievement of SCAN’s Vision and Goals.
- Other duties as assigned.
- Required: Doctoral Degree (M.D.)
- Unrestricted California State Medical License required. Board Certification in one of ABMS categories required.
- 7 – 10 years of clinical experience is required. Geriatric qualification is preferred.
- A minimum of five years’ experience in active clinical practice in an adult-based primary care specialty (preferably Internal Medicine or Family Practice) is required.
- Active recent hospital experience (within the past five years) is desirable.
- Prior experience with Health Plan /Medical Group experience in managed care utilization management, case review, and/or quality improvement activities in a managed care setting is strongly desired.
What's in it for you? Qualified employees will receive:
- A competitive compensation and benefits program
- An annual employee bonus program
- Generous paid-time-off (PTO)
- Ten paid holidays per year
- Excellent 403(b) Saving Plan, providing up to 4% match and vesting after three years
- Casual attire
- A work-life balance and much more!
We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)