MEDICAL DIRECTOR Gottlieb/West Towns PHO
Loyola University Medical Center - Melrose Park, IL

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Gottlieb/West Towns PHO

701 W. North Avenue

Melrose Park, IL 60160

708-450-4945

www.gottliebwesttowns.org

FTE: .3 (12 hours weekly - Part-Time)

General Summary

The Medical Director provides clinical leadership to Gottlieb/West Towns PHO through consulting and advising the PHO on matters regarding physician practice patterns, over and under-utilization of resources, medical necessity, compliance rules and regulations and relationships with payers. The Medical Director is a key member of the organization's leadership team charged with meeting goals of cost, quality and regulatory compliance.

Principal Administrative, Leadership and Clinical Responsibilities

1. Provides mechanisms to support effective clinical decision-making between Utilization Management, payers and physicians

2. Serves as liaison representative regarding physician resource utilization and care delivery issues

3. Provides medical direction for Quality Improvement projects

4. Provides medical director input in relationships with HMO's and ensures compliance with contracted requirements

5. Maintains positive PHO environment

6. Recommends potential growth opportunities for new or existing services within the market

7. Assures compliance with licensing, certification and accrediting bodies

8. Participates in the PHO Contracting, Credentialing & Quality review and Operations & Finance Committees.

Skills and Abilities Required

1. Strong Service Philosophy, Leadership and Interpersonal Skills

2. Excellent critical thinking, deductive reasoning and decision making skills

3. Clinical Expertise

4. Knowledge of Payer Market

5. Knowledge of Care Criteria

Key Job Components

1. UM Case Review

2. Physician and Staff Education

3. Internal and External Physician Liaison

4. Data Tracking / Analysis

5. Process Improvement

6. Strategic Planning

7. Quality Improvement

8. Risk Management

Job Qualifications

  • Prefer minimum 5 years directly applicable experience in managed care, physician management and/or occupational medicine
  • MD or DO with qualifications that meet criteria for hospital medical staff and PHO membership

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