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Act as the Medical Director of Hometown Health and related entities. Assist in developing and implementing Hometown Health Board-approved policies relating to overall patient care programs. Serve as a clinical leader for the plan’s Quality Management, Credentialing, Risk Adjustment and Utilization Management programs. Said duties shall include, but not be limited to, the following:
• Provide guidance to the Hometown Health leadership as it pertains to activities of Quality Management Committees.
• Provide guidance for clinical operational aspects of the plan.
• Provide guidance for clinical operational aspects of the above programs.
• Has responsibilities for oversight of clinical decision-making aspects of the program. Will have periodic consultation with practitioners in the field.
• Will help ensure the organizational objective to have qualified clinicians accountable to the organization for decisions affecting consumers.
• Help monitor the effective implementation of the Plan’s quality Management programs.
• Provides approximately 40% of dedicated time supporting the organizations quality program and activities in capacities specifically designated by the Quality Management program.
In conjunction with the Quality Management Committee, actively pursue the development and maintenance of quality-of-care standards, both in the inpatient and ambulatory sectors.
• Assist in monitoring the results of relevant Quality Management activities and see that these results are communicated to participating physicians. Such information will include both the results of routine monitoring activities, as well as those of problem-oriented studies and analysis, including individual physician performance.
• Provide appropriate follow-up of problems identified through the plan’s Quality Management program.
• Assist in oversight of all clinical aspects of the credentialing programs.
• Act as the clinical lead, in conjunction with the CMO, in leading the Hometown Health Medical Affairs Committee.
• Review all credentialing applications for approval by the Medical Affairs Committee.
Provide direction and support for the clinical utilization review process which includes:
• Support of the Utilization Review Programs of Hometown Health.
• Guidance and support to the Medical Affairs Committee which is responsible for matters pertaining to utilization and credentialing.
• Develop and monitor utilization policies and procedures.
• Communicate utilization issues with providers and provide appropriate follow-up of problems identifies by staff and the Medical Affairs Committee.
Additional Responsibilities include:
• Assist in management for the Medicare Risk Adjustment, chronic condition coding and revenue enhancement program.
• Serve as a member of the HTH strategy and leadership team.
• Assist in the evaluation of and contracting with health care providers and suppliers.
• Assist the plan in analyzing its specialty practice needs and assist in the recruitment of needed physicians.
• Serve as a mediator of potential problems and conflict, both among participating physicians and between physicians and the plan.
• Serve as a physician liaison in the administration of the plan’s enrollee problem resolution procedures.
• Participate in the plan’s budgetary process, particularly as this process pertains to his/her specific areas of responsibility.
• Participate in and facilitate the professional credentialing process (application, privilege delineation, periodic reappraisal, discipline and appeals).
• Provide orientation to new physicians on the plan’s general organizational structure, and policies and procedures. Serve as a liaison between the plan and its contracting physicians.
• Help direct and support all pharmacy programs of the plan.
• Assist in the administration of the chronic condition coding clinic and act as the supervising physician for advanced practitioners requiring supervision.
• The position may require the supervision of advanced practice providers working on behalf of Hometown Health
This position does not provide patient care.
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