The Associate Medical Director reports to HPHC’s Sr. Medical Director and is responsible for the development and implementation of the overall provider engagement strategy in Connecticut for HPHC and for supporting the organization on all aspects of medical performance (cost and quality) related to clinical services obtained by and offered to Harvard Pilgrim members. This individual is the clinical leader for the development and assessment of pay-for-performance and incentive programs for the Connecticut network and will collaborate with other areas such as clinical policy, utilization management, and pharmacy programs. This individual is also accountable for supporting customer/employer needs in the Connecticut market from a sales, support, and account management perspective. In addition, the Associate Medical Director will provide input to key departments throughout HPHC as they relate to the Connecticut market including, but not limited to Contracting, Credentialing, Clinical Programs, Provider Payment Policy, and Information Technology.
Participate in strategic planning and implementation of the provider strategy and network agenda.
Maintain and grow HPHC’s influence and leadership in the areas of network management and clinical quality.
Accountable for managing medical trend in the Connecticut market and developing initiatives to improve cost and quality of care.
Influence the design and coordination of measurement activities associated with clinical initiatives, network performance, and CMS Quality Assessment.
Engage with clinical leadership and key provider groups, including sharing performance data. Support provider tiering initiatives.
Accountable for supporting customer/employer needs in the Connecticut market from a sales, support, and account management perspective.
Oversee development, management and evolution of network pay-for-performance and Quality Grant Programs in Connecticut.
Manipulate and analyze data as it pertains to provider practice patterns, utilization trend management and cost/quality performance improvement; develop provider-facing cost and quality improvement initiatives, oversee implementation and assess impact, including measurement of financial and nonfinancial impact.
Serve on key committees with decision-making responsibilities in areas such as payment policy, medical trend and clinical policy. Support disease management and population health initiatives throughout HPHC’s network and membership.
Support CMO, local market, government relations staff and others on matters of "public" clinical policy.
Other duties and projects as assigned.
This is a part-time positionn.
Graduate of an accredited school of medicine.
Must be licensed to practice medicine in Connecticut, without restriction.
Board certification required.
MBA or other advanced degree desirable.
Minimum 5 years clinical experience; 3-5 years medical management in a health plan or provider organization. Excellent communication, analytic, leadership and management skills.
Harvard Pilgrim Health Care - 15 months ago
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