Evolent Health is looking for the Health Plan Market Medical Director of Vivida Health Plan, a new Florida Medicaid provider sponsored network (PSN) health plan, who is committed to removing barriers to care and keeping Floridians healthy in Region 8.
Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.
We have been named one of Beckers 150 Great Places to Work in Healthcare in 2017, and one of the 50 Great Places to Work in 2017 by Washingtonian. If youre looking for a place where your work can be personally and professionally rewarding, dont just join a company with a mission. Join a mission with a company behind it.
The Market Medical Director (MMD) is a key member of the Vivida Health Plan Senior Leadership Team. The selected candidate will act as the clinical thought leader responsible for developing and executing strategies that both improves the quality of health care delivered to our members and improves cost and efficiency. The MMD will be directly responsible for managing an integrated clinical operation that includes utilization management, care management, population health, quality and pharmacy management. The MMD will be responsible for all the clinical operations, and for establishing and maintaining clinical and medical policies that conform to optimal clinical practice standards. As a collaborative member of a team of nurses, clinicians, physicians, pharmacists, quality improvement, and other health plan leaders, the Market Medical Director will have the opportunity to make a profound impact on the lives of our members.
As a Provider Sponsored Network (PSN) health plan, critical functions of the role include engaging the physician network, organizing physician-led clinical governance and culture, and providing medical direction on all provider network issues. The MMD will have responsibility for managing total cost of care using a collaborative, multi-disciplinary approach, including using value based payment programs aligning to provider network clinical activities and outcomes and managing operational aspects of all clinical programs.
The Health Plan leadership team, including the MMD, will have the added strength of working with the clinical, financial, analytics, and operational services of both Evolent Health and the primary provider PSN entity, Lee Health, to support the local health plan needs and functions. Evolent Health is the primary operating partner supporting almost all clinical and health plan operations for Vivida Health.
Vivida Health is the only Provider Sponsored Network (PSN) health plan in Floridas managed Medicaid Managed Medical Assistance (MMA) program in Region 8 that includes Charlotte, Collier, DeSoto, Glades, Hendry, Lee, and Sarasota counties. Vivida Health headquarters and main office is in Fort Myers, Florida.
The Health Plan Market Medical Director (MMD) will report directly to the Evolent Health Associate CMO but will set priorities and direction with the Lee Health VP Clinical Strategy and Population Health who is also the Vivida Health CMO. The Vivida Health Market Medical Director will be 100% dedicated to Vivida Health.
Physician and provider relationship management
- Responsible leading change with physicians and other providers to improve the quality and efficiency of care in the network and integrate these providers into our clinical initiatives, including creating and maintaining a system that gives continuous feedback on these initiatives
- Visits network facilities on a regular basis, identifies key issues facing leaders and works collaboratively with leadership to accomplish mutually agreed upon goals
- Participates in the development of physician incentives, value based contracting arrangements, pay for performance and targeted network improvement programs
- Partners with Evolent Health analytics to provide meaningful and actionable information to physicians
- Lead and support activities related to communications, physician/provider engagement, and programming including outward facing membership growth and organizational visibility and success
Population Health collaborative care management leadership
- Provides clinical leadership and development for population health programs or functional areas within Medical Management
- Serves as a lead physician on the medical management team working closely with clinical and market leadership, in addition to providing direction for program development of the Medicaid line of business (LOB)
- Serves as the chairperson for the Physician Advisory Committee (PAC) and other physician-led committees
- Assists in assuring appropriate health care delivery for the assigned membership and managing the medical costs associated with the assigned population
- Promotion of managed care systems using evidence-based medicine to educate and facilitate best practices with care management staff and medical physicians/providers
- Participates in Physician/Practice Meetings
- Responsible for executing and maintaining Evolent Healths benchmarked Utilization/Cost Management Program and relevant Clinical Quality Improvement Programs
- Participates as needed as part of Evolent Healths national UM Medical Director team to assure quality of care in all aspects of medical utilization and to assure that utilization is appropriate to meet the needs of the members and falls within recognized standards of efficiency
- Participate in the Appeals and Grievance process, as necessary, to assure timely and accurate responses to members
- Supports and leads, as needed, operational performance to develop and implement the health plans clinical guidelines and protocols that can be utilized through the quality improvement, utilization management, and case management processes to positively impact the delivery of care.
- Collaborates as needed with risk management, claim adjudication, pharmacy utilization management, catastrophic case review, outreach programs, HEDIS reporting, site visit review coordination, triage, provider orientation, and others
Quality of care and service delivery
- Provides guidance and interpretation on issues of medical appropriateness, benefit application as appropriate, level of care necessary to include out-of-network care
- Evaluates and ensures systems and processes to assist physicians/providers with adherence to evidence based protocols
- Assures compliance related to Federal (e.g., CMS), State (e.g., Insurance commission) and local rules and regulations
- Works closely with community provider leaders to ensure accurate understanding of the Companys mission and goals and quick response to any provider issues and questions regarding Company performance and progress
- Identifies and implements other strategies that insure quality care, access to care, and the financial success of the Company
- Graduate of an accredited medical school. M.D. or D.O.
- Active physician license without any restrictions
- 3-5+ years of clinical practice in a primary care setting preferred and progressively responsible medical administrative experience
- Board certification in ABMS recognized specialty
- 3-5+ years of managed care or population health experience