Professional Services Director - Healthcare jobs in Pennsylvania

Position: North East Regional Medical Director

Monogram Regional Medical Directors are quality driven physicians who are dedicated to improving the well-being, quality of life, and health outcomes for our patients. We partner with the nation's leading clinical specialists to create transformative polychronic care. Monogram Health uses next generation AI algorithms to predict necessary care to promote the delay of complex disease progression, such as chronic kidney disease and the seamless transitions to dialysis, pre-emptive kidney transplant, conservative management.

The Regional Medical Director is a key clinical leader within Monogram Health who contributes to the development and oversight of clinical strategies, policies, programs, processes, protocols, guidelines, and operations that drive improved patient health outcomes in conjunction with the Practice Medical Directors to motivate and provide medical direction in pursuit of evidence based and cost effective, quality healthcare.

The Regional Medical Director will plan, organize and supervise appropriate clinical and operational aspects of their regional market in conjunction with their assigned Practice Medical Directors. The North East Regional Medical Director will support the East Region in states PA, NJ, CT, DC, DE, MA, RI, and VT.

Roles and Responsibilities

• Reduce unnecessary episodes of care, including hospital readmissions
• Analyze data built by Practice Medical Directors and ensure care goals are achieved
• Identify quality of care issues for health plan clients
• Optimize patient health outcomes and total performance against health plan contracts across multiple specified markets
• Lead efforts to share and explain all clinical policies, procedures and guidelines with Monogram employees and our physician partners
• Represent Monogram as a clinical leader to health plans, providers, and other organizations
• Monitor and assist Practice Medical Directors regarding care management and practice operations within your market
• Monitor Practice Medical Directors across multiple markets and their respective clinical metrics and goals for delivering improved health outcomes at a lower total cost of care across your market
• Remain available for occasional coverage of Practice Medical Director responsibilities
• Take responsibility for quality outcomes for multiple panels of health plan members in specified geographic regions
• Utilize IT and data tools to report, monitor, and improve quality and utilization
• Assist Practice Medical Directors to conduct retrospective reviews of hospitalizations and dialysis treatment episodes to ensure Monogram's care management services are effectively rendered
• Assist Practice Medical Directors to oversee the implementation and continual refinement of the clinical strategies, evidence-based clinical care guidelines, and care management programs for effectiveness and efficiency
• Identify regional trends and implement actions plans to improve population health outcomes
• Create a work environment that fosters fulfilment and personal development for employees and encourages empathy and compassion toward patients
• Support Monogram as necessary with any tasks required to deliver excellent personalized clinical care and perform all other duties as assigned
• Develop and maintain compliance with regional budgets
• Assess, develop and recommend strategies for compliance with regulatory requirements
• Uphold the mission and values of Monogram Health in all aspects of your role and activities
• Other duties as requested

Position Requirements

• This position will be remote within the designated market with occasional in-home patient treatment visits and occasional domestic travel

• Demonstrated experience applying evidence based clinical criteria
• Strong management and communication skills

• Active, unrestricted state medical license required in each state within the market

• Experience with high need Medicare Advantage and managed Medicaid populations
• Experience with NCQA, HEDIS, Medicaid, Medicare, quality improvement, medical utilization management, and risk adjustment
• Current state medical license without restrictions to practice and free of sanctions from Medicaid or Medicare. Willingness to become licensed in multiple states.

• MD (Medical Doctor) or DO degree from an accredited medical school

• BC or BE in an ACGME approved specialty such as Nephrology, Internal Medicine, Family Practice, Emergency Medicine, Critical Care, Cardiology, Endocrinology, Hepatology, or Geriatrics.

Benefits

• Opportunity to work in a dynamic, fast-paced and innovative value-based provider organization that is transforming the delivery of kidney care
• Competitive salary and opportunity to participate in the company’s bonus program
• Comprehensive medical, dental, vision and life insurance
• Flexible paid leave and vacation policy
• 401(k) plan with matching contributions

About Monogram Health

Monogram Health is a next-generation, value-based chronic condition risk provider serving patients living with chronic kidney and end-stage renal disease and their related metabolic disorders. Monogram seeks to fill systemic gaps and transform the way nephrology, primary care and chronic condition treatment are delivered. Monogram’s innovative, in-home approach utilizes a national nephrology practice powered by a suite of technology-enabled clinical services, including case and disease management, utilization management and review, and medication therapy management services that improve health outcomes while lowering medical costs across the healthcare continuum. By focusing on increasing access to evidence-based care pathways and addressing social determinants of health, Monogram has emerged as an industry leader in championing greater health equity and improving health outcomes for individuals with chronic kidney and end-stage renal disease.

At Monogram Health we believe in fostering an inclusive environment in which employees feel encouraged to share their unique perspectives, leverage their strengths, and act authentically. We know that diverse teams are strong teams, and welcome those from all backgrounds and varying experiences.