Senior Medical Director, Managed Care Services

Managed Care Operations Chicago, Illinois


Description

Company: Oak Street Health

Title: Senior Medical Director of Managed Care Services

Company Description

The mission of Oak Street Health is to rebuild healthcare as it should be. We are a rapidly growing, innovative company of community-based healthcare centers delivering higher quality health and wellness care that improves outcomes, manages medical costs and provides an unmatched experience for adults on Medicare. The Oak Street model integrates outstanding clinical expertise, technology, and teamwork to deliver improved care quality and cost savings. These cost savings are then reinvested into care in our communities, creating a virtuous cycle of improving community health. We are a national organization serving over 100,000 patients and we are growing rapidly. We are a diverse team of care providers, service team members, technologists, community outreach experts, business professionals, and more -- all dedicated to our Oaky Values and motivated by our mission. We’re looking forward to getting to know you!

For more information, visit www.oakstreethealth.com.


 

Role Description:
 

The Senior Medical Director will join Oak Street Health at a critical time in the history of our company and of primary care. The opportunity for impact is large and growing, and Oak Street is leading the transition from fee-for-service to value-based care.

This position will be responsible for leading the team of physicians involved in utilization management review as well as other services delegated to Oak Street Health on behalf of its payer partners. The Senior Medical Director will work closely with the Vice President of Managed Care Services and Population Health teams to collaborate on a data-driven approach to utilization management and other delegated services, with the goals of improved clinical outcomes and decreased medical costs. This position will report to the Chief Clinical Officer.

Core Responsibilities:
 

In addition to clinical duties of center based primary care 1.5 days per week, the Senior Medical Director is responsible for the following leadership and administrative duties:

  • Direct Supervision of Utilization Management Clinician Reviewers: This physician will lead a team of clinicians hired by Oak Street Health to review the utilization management of healthcare services rendered for patients. This team will perform utilization management review as delegated to Oak Street Health on behalf of its payer partners, and will work with sub-delegated parties (e.g., Innovista, Humana CDO) as necessary in accordance with payer contracts. This physician will also assure the quality of utilization management reviews carried out by these sub-delegated partners.

  • Primary Physician Presence for Value-based Contracting with Payers: The Senior Medical Director will serve as the primary external-facing physician for clinical aspects of the value-based contracts with payer partners. In particular, this physician will assist with negotiations and follow-up discussions regarding quality bonuses and delegated services (utilization management, complex care management, model-of-care), working alongside the Vice President of Managed Care Services.

  • Partnership with Operational and Strategy Partners in Population Health: By partnering with leaders in the Population Health organization, the Senior Medical Director will ensure a data-driven approach to utilization management and optimize its impact within Oak Street Health.

  • Close Coordination with Care Services: Through close coordination with leaders in the Care Services organization, this position will contribute to the development and piloting of new care management functions which can leverage data from utilization management to impact clinical care and avoid downstream costs. This work may also involve contributing to product design in order to clinically integrate the work of delegated services into the electronic health record.

  • Partnership with Field Clinical and Operational Leadership: The Senior Medical Director will serve as the voice of delegated services and represent the work for primary care physicians in the field, setting expectations for engagement and collaboration on delegated services efforts.

  • Fostering Culture: At Oak Street, we foster a culture of innovation and open dialogue, and we work with urgency. This requires passion, active listening skills, and a comfort with and commitment to regular change. Our Senior Medical Director is expected to support this culture and set an example for others to follow.


 

What are we looking for?
 

Ideal candidates will satisfy the following:

  • Passionate about their work and motivated to be a part of a fast growing organization.

  • M.D. or D.O. graduates.

  • Board certified.

  • Other professional degrees (e.g., M.B.A., J.D., M.P.H.) welcome but not required.

  • Minimum of 5 years of experience in clinical practice.

  • Minimum of 3 years of experience in a physician management role or role as medical director.

  • Experience in clinical leadership roles, leading and coaching physicians to be the best they can be for their patients and their colleagues.

  • Experience using a metrics-driven approach to analyze cost, quality, and satisfaction data to drive clinical strategy and program redesign.

  • Understand the basics of managed care and recognize that population health and a focus on smart allocation of scarce resources can lead to high value care (better care, lower cost).

  • Ability to collaborate effectively with staff, providers, and a diverse group of leaders. 


 

What does being “Oaky” look like?

  • Radiating positive energy

  • Assuming good intentions

  • Creating an unmatched patient experience

  • Driving clinical excellence

  • Taking ownership and delivering results

  • Being scrappy



 

Why Oak Street?


Oak Street Health offers our coworkers the opportunity to be at the forefront of a revolution in healthcare, as well as:

  • Collaborative and energetic culture

  • Fast-paced and innovative environment

  • Competitive benefits including paid vacation and sick time, generous 401K match with immediate vesting, and health benefits

Oak Street Health is an equal opportunity employer. We embrace diversity and encourage all interested readers to apply to oakstreethealth.com/career