Vice President, Medical Director of Physical Medicine and Pain Management
ASH Companies - San Diego, CA

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The primary purpose of this position is to provide medical management leadership and direction for American Specialty Health Specialty Network programs (with a focus on Physical Medicine and related clinical services) through personal hands-on involvement in day-to-day medical management decision making and through leadership and management of the medical management team.

Responsibilities include:
  • Provide Medical Oversight and Medical Management: Medical management support to the Senior Vice President, Chief Health Services Officer, and Chief Executive Team members, and clinical and administrative staff as required.
  • Supports review and authorship of RFP documents and other marketing or sales activities as requested by CEO and CHSO.
  • Develops and authors business specifications documents, guidelines, and other infrastructure policies and procedures in collaboration with Key Process Teams and Clinical Committees.
  • Provides medical support and clinical decision-making to support ASH Group products directed by CEO and CHSO and Sr VP Clinical Services.
  • Including:
o Medical oversight and medical decision-making.

o Authorship of specifications documents; guideline drafts; clinical decision-assist criteria and other documents required to execute the duties of the position.

o Supports Clinical Quality Administration functions including building and documenting systems for medical management components of the programs.

o Reviews quality cases and makes medical management decisions.

o Oversees clinical quality activities as required including review quality.

o Contributes to product and process development, implementation and management.

o Provides medical editing and supports document development.

o Supports clinical evidence review committees and quality committees as assigned.

o Supports development of medical risk management Supports external medical relationships to support ASH goals.

o Provides connection to the medical industry (e.g. Medical Associations).

o Provides support to budgeting; planning; corporate development.

o Assists with coordinating and collaborative projects that involve medical decision-making.

o Supports design, implementation and monitoring of clinical QI initiatives.

o Contributes to Evidence Evaluation Committee research and guideline development activities.

o Cross-functional collaboration with operations and other administrative teams through Line of Business; Key Process Teams, and committees Contributes to design, analysis, and communication of health outcomes measurement metrics.

o Provides medical expertise to ASH health services research initiatives.

o Management of field based MD support and provides backup appeals review support.

  • Staff management:
o Provides oversight, supervision and management of assigned staff.

o Oversight of performance and clinical review by consulting medical physicians.

o Provides staff training as required.

o Provides coaching, training, annual performance reviews for staff.

  • Escalates risk management concerns to Senior Management.
  • Obtains and maintains Medical Doctor credentials active, unencumbered, and in good standing.
  • Obtains and maintains Medical Doctor state licenses in states required by ASH business needs.
  • Maintains clinical knowledge and expertise in clinical fields applicable to job duties and Board Certifications.
  • Performs other duties and responsibilities as assigned.
Education/Training/Experience/Licenses

  • Graduate of an accredited medical college and Board certified. Must have a current, unrestricted medical license in the state of California and be able to obtain state medical licenses in other states as needed.
  • Active Board Certification in Orthopedics or Physical Medicine and Rehabilitation or Pain Management issued by an accepted medical Board.
  • Minimum 8 years of clinical practice experience required.
  • Experience as full-time medical director for a full-service medical health plan / insurance company.
  • Supervisory experience including design and operations of medical management systems and processes within an NCQA and/or URAC accredited Health Plan.
  • Experience in Disease Management, Care Coordination, Utilization Review, Clinical Quality Improvement, Clinical Coding, Network Management, Health Information Technology, and Credentialing experience preferred.
  • Valid Driver’s license with good driving record. Availability of automobile for on the job use and proof of insurance.
Knowledge/Skills/Abilities:
  • Excellent communication skills and computer skills.
  • Excellent medical management skills.
  • Able to succeed in a very dynamic, rapidly changing, and entrepreneurial organization.
  • Demonstrated ability to collaborate and work with practitioners of other disciplines and within a wide body of clinical evidence.
  • Demonstrated ability to interact in a positive, respectful m a nner and establish and maintain cooperative working relationships.
  • Desire to learn new systems and effectively integrate new ideas into established systems and product designs
  • Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
  • Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
  • Ability to effectively organize, prioritize, multi-task and manage time.
  • Demonstrated accuracy and productivity in a changing environment with constant interruptions.
  • Demonstrated ability to analyze information, problems, issues, situations and procedures to develop effective solutions.
Mobility - Primarily sedentary, able to sit for long periods of time.

Physical Requirements - Ability to speak, see and hear other personnel and/or objects. Ability to communicate both in oral and written form. Capable of using a telephone and computer keyboard. Ability to lift up to 10 lbs. Ability to travel within the facility. Ability to drive and travel by air.

Environmental Conditions - Usual office setting.