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Senior Medical Director - (15844)

Universal Health Services


Location:
RENO, NV
Date:
01/17/2018
2018-01-172018-02-15
Job Code:
15844
Universal Health Services
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Job Details

Deltek Talent Management - Senior Medical Director - (15844)

Job Details


Senior Medical Director - (15844)

Facility Name
Prominence Health Plan
Location
RENO, NV 89502 US (Primary)
Career Area
Allied Health
Category
Administration
Job Description

Founded in 1978, Universal Health Services, Inc. (UHS)* is one of the nation’s largest and most respected healthcare management companies, operating through its subsidiaries—acute care hospitals, behavioral health facilities and ambulatory centers nationwide. With more than 74,000 people employed by UHS subsidiaries, UHS’s business strategy is to continue to grow by building or purchasing healthcare facilities across the country, while continuing to strengthen UHS’s well-reputed franchise with its customary exceptional service and effective cost control. Our success is driven by a service philosophy based on integrity, competence, compassion, and a responsive management style. UHS has been recognized as a Fortune 500 company and is listed as one of Fortune’s Most Admired Companies. UHS’s Acute Care Division is comprised of 25 high performing hospitals and several ambulatory care facilities across the nation and prides itself on providing superior patient care. 

Prominence Health Plan, established in Reno in 1993 as St. Mary’s Health Plan, was acquired in 2014 by Universal Health Services (UHS), one of Fortune Most Admired Companies. In addition to the HMO, Prominence Health Plan also offers Point of Service health plans, a preferred health insurance company that offers Preferred Provider Organization (PPO) health plans, and CDS Group Health, a third-party administrator.

We are a fast-growing, rapidly-changing healthcare organization offering the excitement of a start-up with the support of a Fortune 500 company. We are looking for talented, enthusiastic people to help shape the future of our organization.

Job Summary: Reporting to the President and Chief Executive Officer of Prominence Health Plan (PHP), the Senior Medical Director will direct the development of goals and objectives and the activities related to their achievement for the Medical Management Service Department of PHP which include Utilization Management, Case Management, Disease Management, Quality Improvement, Pharmacy Management, and Risk Adjustment. The Senior Medical Director will provide leadership for the above mentioned departments and may be asked to participate with and lead other multi-disciplinary or cross-functional task-oriented groups within PHP and as appropriate other internal and external units.

This individual will play a key role in the direction and execution of the PHP success in Nevada, Texas, and other markets as indicated related to the delivery of medical services in a population management environment. This medical leader will be responsible for strategically developing and enhancing the existing Medical Management Service Department in the areas of medical policy and procedures, utilization management, pharmacy management, quality of care, quality of service, physician enhancement and development, case/disease management, and appropriate documentation and coding. Furthermore, this medical leader will, as necessary, provide the skills and experience necessary in working with the marketing and sales department to assist in new membership growth and as necessary key account retention. 

A key component of the position is that this leader is the face of PHP with the clinical community.  As such, the Senior Medical Director will be expected to work closely with Provider Relations, represent the organization at key community clinical functions, be visible at important regional and national meetings, and visit medical/hospital entities on a regular basis.

Job Requirements
  • Board Certified in a primary care or medical/surgical/behavioral specialty.
  • At least three years previous experience as Medical Director and/or Senior Medical Director
  • At least three years’ experience in medical management such as UM, CM, DM, risk adjustment, and quality/pharmacy
  • Experience and knowledge of HEDIS/CAPHS/HOS/NCQA
  • Minimum five years clinical practice
  • HMO/Managed Care/Population Management experience. Prefer Peer Review, medical policy/procedure development, care integration and/or provider contracting experience
  • Minimum 2 years’ experience in administrative or similar position responsible for developing business communications or correspondence.
  • Doctorate Degree in Medicine Master's in health care administration or related field (MBA, MMM, MPH or MHA) preferred.
  • Valid Medical License in states PHP services (free of sanctions from MD Medicaid or Medicare).
  • A current license to practice without restrictions

Language Skills:

 

  • Ability to effectively communicate in English, both verbally and in writing.

     

Skills:

 

  • Excellent computer skills.

     

  • Strong internal relationship building skills required.

     

  • Strong external relationship skills required with contracted providers.

     

  • Excellent presentation, oral and written communication skills required.

     

  • Able to travel to all PHP markets and represent the Plan.

     

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