POSITION MISSION: Participates and has direct oversight responsibility on a wide range of management duties including staff recruiting, development, and in-service: internal management, quality and utilization management; external linkages; education; and coordination of clinical related information systems.Advises the Executive Committee regarding clinical policies and procedures and administers approved clinical policies and procedures.Is directly responsible for quality and utilization.
ESSENTIAL JOB FUNCTIONS: ·Participation in the recruitment of physicians and other non-physician key clinical staff. ·Assures proper evaluation of physicians and other key clinical staff on an annual basis. ·Participation in the on-going in-service and on-going training and staff development of physician and other key clinical staff. ·Responsible for the operational team responsible for: Utilization Management, Quality Improvement, and Credentialing. ·Participate in planning and program development and implementation within the HCP structure. ·Acts as a resource to Contracting, Network Development, and Provider Relations department operational teams. ·As a member of the Executive Committee, advise Committee as to the need for updates/revisions to clinical service operations policies and procedures. ·Administers policies and procedures related to clinical services operations. ·Facilitate interdepartmental coordination and integration within clinical service departments. ·Ensure high quality care is maintained at all levels of health care delivery in the network and MSO. ·Serves as a chair of the Utilization, Quality Management, and credentialing Committees. ·Assure compliance with HCP, health(s), and regulatory standards. ·Participate in the development in the development and adoption of clinical criteria utilized by HCP. ·Acts as liaison between HCP and Healthplan(s), physicians, facilities, and ancillary providers. ·Deals with government and other regulatory agencies regarding national, state, and local health care issues. ·Acts as key contact for public and community relations. ·Participates in the training of HCP physician network. ·Participate in negotiations and recruitment of new HCP participating physicians.
POSITION DESCRIPTION
QUALIFICATION REQUIREMENTS: Skills, Knowledge, Abilities: ·Advanced verbal communications and interpersonal skills ·Analytical abilities in order to organize, plan and coordinate assigned duties in accordance with HCP goals and objectives ·Knowledge of the organization and operation of complex health care organizations, alternate delivery systems, medical staff relations , and utilization issues ·Knowledge of managed health care on the provider side ·An in-depth understanding of the medical aspects of the health care field ·Management and leadership experience Training/Education: ·Licensed to practice in the state of New York ·Board certified Experience: ·Minimum of five (10) years clinical practice experience
POSITION REPORTS TO: Vice President of Administration
POSITIONS SUPERVISED: None The statements herein are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skill required of personnel so classified.