The Clinical Group East Medical Director, reporting to the Vice President of Medical Affairs, provides clinical oversight and leadership as well as direct care to CCA’s members with complex physical, behavioral health and social needs. They will also play an important role in the financial stewardship of our unique organization.
This position is responsible for providing medical oversight to our large Clinical Group East, based in Charlestown, MA, partnering with the Clinical Director to lead the development of clinical practice guidelines, ensure appropriate clinical supervision of advanced practice clinicians, spearhead clinical quality and performance improvement initiatives, clinical risk management, achieve practice-level and individual patient quality outcomes, and support clinical best practice adoption with specific focus on providing appropriate care to frail elderly patients and furthering the integration of behavioral health and primary care services. In addition to this clinical role, the incumbent will be responsible for helping to determine the appropriateness and equity of care services for our uniquely complicated population of dual-eligible adults.
The direct patient care in this role involves providing clinical supervision to home-visiting nurse practitioners, physician assistants and nurses who are managing members with complex physical, cognitive and behavioral health needs, as part of an interdisciplinary team. This includes occasional joint home visits with CCA clinicians, engaging with primary care and specialist physicians in care plan development, regular consultation and case review, and rarely assuming full primary care provider responsibilities for members with complex needs. Additionally, the Medical Director will participate in out-of-hours on-call duties, as well as being available to telephonically triage calls and discuss cases with other clinicians on the care team.
Specific responsibilities include:
- Interface with PCPs, specialists, and hospitals to promote an understanding of CCA’s unique model, facilitate collaboration and shared decision-making
- Clinical oversight and supervision for advance practice clinicians delivering augmented primary care and care management to CCA members
- Monitoring, evaluation, and quality improvement activities
- Active participation in CCA’s Ethics Committee, Clinical Effectiveness Committee, Clinical Leadership Group, and the MD Group, and other roles as appropriate and as requested by the VP of Medical Affairs or Chief Medical Officer.
- Program development and integration of clinical innovations, including inpatient services, community paramedicine, care transitions, LifeChoices palliative care program, and others
- Participate in development of educational content around complex care delivery, geriatrics and palliative care tailored to CCA (Commonwealth Care Alliance) / CCC (Commonwealth Community Care) clinicians
- Medical necessity reviews for acute (inpatient vs observation) level of care, as well as for service authorization requests
- Second level reviews of member appeals and quality of care concerns
- Provide physician review for quality of care concerns, appeals, denials, and level of care decision-making, in a patient-centered manner that is consistent with CCA’s values
Essential Duties & Responsibilities
- Functions as clinical oversight for CCA Clinical Group clinicians. Is available Monday – Friday 8 a.m. – 6 p.m. to provide clinical support for Advanced Practice Clinicians and RNs.
- Documents all clinical work in a timely manner and provides the necessary documentation required for data collection and billing purposes.
- Participates equally in all call responsibilities.
- Serves as medical director for appropriate functional areas
- Attends clinical team meetings and other mandatory educational sessions.
- Conducts educational and training activities that promote appropriate and effective patient care
- Participates in the planning, implementation and coordination of health education and counseling of the patient and family. Teaches families and caretakers how to provide safe, effective care and promote optimum function for patients at home. Documents the level of understanding and response to teaching.
- Provides educational updates to clinical staff.
- Participates in orienting and training new employees as required.
- Participates in quality assessment and quality improvement within CCA as a whole
- Participates in annual clinical team retreats and social / teambuilding events
- Maintains required professional credentialing and appropriate CME standards
- Attends external meetings and activities as a representative of the organization as requested
Qualifications & Skills
- MD or DO degree from an Accredited institution
- Board Certified or Board Eligible in Family Practice or Internal Medicine
- Interest and experience in serving complex, vulnerable and disabled populations is essential
- Experience with quality improvement, monitoring and evaluation, health systems strengthening, innovation and training is desired, although not essential
- Additional work experience as a geriatrician in a low-resource/community health center, PACE, SCO, One Care experience welcomed, but not necessary
- Proven skills, knowledge base and judgment necessary for independent clinical decision-making
- Excellent organizational, time-management and problem-solving skills
- Ability to function effectively as part of a multi-disciplinary team and to independently develop and execute an agenda
- Effective oral and written skills
- Strong interpersonal skills
- Commitment to social justice in medicine and an understanding of healthcare reform
- Effective teaching and mentorship skills
Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws