OUR WHY: 5-STAR SERVICE CULTURE
At at VIPcare, it’s our commitment, our passion, and our culture that sets us apart. We don’t just talk the talk - we believe in it and live by it. We are revolutionizing the healthcare industry by focusing on quality, not quantity. Our core value is always to deliver 5-Star Service. And by doing so, we are successfully able to achieve our mission of Better Health.
VIPcare is an IPA/MSO that aligns payors and providers across all populations with the people, processes, technologies, and information to transition to value-based care and achieve high-quality, cost-effective care with patients and physicians.
We are a preferred partner for driving value-based care adoption and delivering personalized, secure, and seamless healthcare experiences. We take great care of our team, patients, providers, and affiliates. To us, it’s about providing quality care for better outcomes! When our patients win with Better Health, VIPcare wins.
Summary/Objective:
The Associate Medical Director is primarily involved with leading the Referral Redirection Team, the Preferred Provider Network, and meeting with Primary Care Providers to develop action plans to help improve utilization and provide better health for patients. They are accountable for actioning referrals routed to Non-Preferred Network consultants and to Outpatient Hospitals. These referrals are then steered towards generated Preferred Networks as well as appropriate Sites of Service. The Associate Medical Director is also responsible for identifying and correcting actions of variance PCPs to improve their clinical and cost performance. Measures of success are improvements in Inpatient, Outpatient Hospital, and Professional Physician Services.
Essential Functions:
• Lead the Referral Redirection Team to ensure the correct use of the Preferred Network and appropriate Site of Service.
• Conduct peer-to-peer calls to effectuate redirection of the Preferred Networks.
• Conduct office or teleconference visits for assigned variance PCPs to improve their utilization and cost performance.
• Collaborate with the Senior Manager Analytics to identify reasons for off-track PCPs.
• Participate in daily Inpatient rounds as well as weekly Skilled Nursing Facility (SNF) rounds.
• Conduct peer-to-peer calls and meetings with Hospitalists and SNFists on individual cases as off-track performance.
• Accountable for achieving Admissions/1000, Readmission %, and Outpatient/1000 goals.
• Accountable for increasing the use of the developed Preferred Networks and provide corrective actions for Non-preferred Networks users.
• Responsible for leading the referral team in processing referrals generated for specific Affiliate PCPs.
• Responsible for redirecting referrals generated for Outpatient Hospitals to more appropriate Sites of Service, such as Ambulatory Surgery Centers (ASCs) or Free-Standing Imaging Centers (FSICs).
• Lead Health Services and other assigned sections of regional meetings for both Affiliates and VIPcare.
• Support all out-of-state/territory expansion efforts and effectuate similar programs and oversight
Required Education/Experience:
• Medical Degree from an accredited medical school.
• Licensed to practice medicine in the state of Florida
• Licensure to be obtained for additional states or territories as required
• Board Certified in a specialty recognized by the American Board of Specialties (ABMS).
• 3 or more years of clinical experience.
• 3 or more years of managed care experience.
• Experience in Utilization Management and Physician Improvement Programs.
• Experience in  Medicare Advantage.
• Experience in Value-Based model of care
• Experience in leadership roles and project management.
• Experience working with high performing teams and leading organizational change efforts.
• Experience and expertise in medical cost reduction activities.
• Understanding of medical analytics and reporting.
• Provide medical knowledge to facilitate the resolution of complex issues and required decisions.
• Working knowledge of medical policy and application of criteria.
• Ability to manage multiple priorities in an expedient and decisive manner.
• Ability to manage difficult peer to peer situations arising from medical care reviews.
• Must possess excellent communication skills to interface with providers, team members, and health plans.
• Strong interpersonal and presentation skills.
• Appreciation of cultural diversity and sensitivity towards target populations.
Additional Eligibility and Qualifications:
• Bilingual - Spanish mandatory (written and verbal testing will be required)
• Experience with Clinical Operations and Medicare.
• Understanding of SNF, Hospitalist, and Provider Network market.
• Understanding of Healthcare Best Practices ranging from Clinical to Hospital processes and procedures.
• Understanding of the terminology, techniques, and reimbursement mechanisms employed in the delivery of healthcare including, but not limited to clinical coding (ICD-10, CPT, and DRG), medical record review, population health, and EMRs.
• Ability to use Electronic Medical Record (EMR) system to review Patient records.
• Proficiency in Medicare Risk Adjustment.
• Effective communication and interpersonal skills.
• Proficiency in Google Suite products such as Google Docs, Google Sheets etc.
• Valid Florida Driver's License.
• Proven track record of achieving results.
Supervisory Responsibility:
• Responsible for the Referral Redirection Team.
• Report directly to the CMO.
Work Environment:
• This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones and fax machines.
• The Associate Medical Director works remotely with occasional travel to the Tampa Headquarters office.
• Occasional travel to variance Physician, Specialist, and Hospitalist locations.
Physical Demands:
• Ability to spend an extended amount of time facing a computer screen.
Position Type/ Expected Hours of Work:
• This is a full time position and core hours of work and days are Monday to Friday 8:00 a.m. - 5:00 p.m.
• Extended hours to accommodate urgent and emergent tasks will be expected.
Travel
• Travel PRN (i.e. PCP Offices, Specialists, Hospitalists, and SNF visits).
Executive Employment Type: Full-Time