Medical Director, Quality Improvement- CFHP

Job description

POSITION SUMMARY
The Medical Director of Quality Improvement, at Community First Health Plans (Community First), will serve as a visible physician leader whose task is to champion quality & safety, customer satisfaction, efficiency, and access. The Medical Director will partner with senior leadership across the organization and throughout the organization’s service region to continue to strengthen and grow data-driven, member-centric, population-based quality management strategies, integrating physical, behavioral, social, and cultural determinants of health designed to produce positive health outcomes. Management responsibilities include consulting with and advising senior members of the organization on matters regarding provider practice patterns, utilization of resources, medical necessity, compliance rules and regulations, collaboration and relationships with payers and the community, and clinical documentation improvement. The Medical Director of Quality Improvement will build robust relationships with community partners and engage strategically with participating providers in the network sharing quality data and implementing initiatives with shared goals of improving member’s health. Promotes and supports an environment of continuous quality improvement in all aspects of service to its members, providers, staff, and community.
EDUCATION/EXPERIENCE
Medical degree as Doctor of Medicine or Osteopathy and an active and unrestricted Texas Medical License, free of sanctions from Medicaid or Medicare is required. Board certification from the American Board of Medical Specialties is required (primary care specialty is preferred). Master’s degree with formal education in ambulatory-based medical management, public health, or business administration is preferred. A minimum of five years of clinical experience and three years of managed care experience is preferred. Previous HMO or PPO leadership position experience is preferred with knowledge and understanding of components of population health management including utilization review and quality management.
LICENSURE/CREDENTIALING
Must possess a current active and unrestricted license to practice medicine in the State of Texas. Maintain Board certification from the American Board of Medical Specialties. Must follow rules/regulations as set forth by the Texas Medical Board Medical Practice Act.