Health Net, Inc. is a publicly traded managed care organization that delivers managed health care services through health plans and government-sponsored managed care plans. Its mission is to help people be healthy, secure and comfortable. Health Net, through its subsidiaries, provides and administers health benefits to approximately 5.4 million individuals across the country through group, individual, Medicare (including the Medicare prescription drug benefit commonly referred to as "Part D"), Medicaid, U.S. Department of Defense, including TRICARE, and Veterans Affairs programs. Health Net's behavioral health services subsidiary, Managed Health Network, Inc., provides behavioral health, substance abuse and employee assistance programs to approximately 4.9 million individuals, including Health Net's own health plan members. Health Net's subsidiaries also offer managed health care products related to prescription drugs, and offer managed health care product coordination for multi-region employers and administrative services for medical groups and self-funded benefits programs.
For more information on Health Net, Inc., please visit the company's website at www.healthnet.com.
The Chief Medical Director & VP Health Care Operations is responsible for strategic design and overseeing the implementation of HNGS' provider network and medical management policies and programs to ensure the best quality of care for Health Net's Department of Defense, Veterans Administration, and government members. This position works closely with Health Net's other clinical departments and serves as a member of the senior team that oversees Health Net's corporate medical management and provider network management programs and policies, while supporting HNGS's goals and objectives.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Provides leadership and direction to the HNGS medical director staff, including appeals and grievances and professional review activities.
- Monitors the performance of all medical and behavioral/care coordination and management of clinical and quality network performance of the provider networks, assuring fulfillment of requirements set by the Department of Defense, Veterans Affairs Programs and/or any other government customers requiring medical management or care coordination.
- Participates in the corporate Health Care Services Team discussions as guided and lead by the corporate Chief Medical Officer.
- Participates in the development and implementation of medical protocol standards, programs to manage utilization and maintain clinical best practices, and programs to improve the quality of medical services provided by physicians and other providers.
- Accountable for standards of care, standards for pre-authorization of treatment for members and clinical risk management.
- Oversees the development and management of the Provider Network.
- Develops and coordinates efforts with the Provider Network team and assists with development and implementation of effective provider education/intervention programs to address unwarranted or outlier clinical care or quality of practices/variation.
- Collaborates and integrates efforts with the provider network development, Pharmacy, MHN and other clinical leaders in the implementation of member-impacting programs and initiatives as needed for the business units.
- Prepares and manages short-term plans and budgets.
- Collaborates with cross-functional peers to effectively manage health care costs and trends.
- Ensures that all organizational activities and business operations are carried out in compliance with company policies, and local, state, and federal regulations and internal requirements.
- Provides effective leadership to staff, with attention to the recruitment, mentoring and ongoing leadership of the organization.
- Responsible for associates' work climate and provides leadership for initiatives to make the department a great place to work.
- Graduate of an accredited medical school
- Doctorate Degree in Medicine
- Board certification in an ABMS recognized specialty
Current board certification in a primary care field
Unrestricted active MD license
Knowledge, Skills & Abilities:
- Minimum ten years clinical practice experience with a medical group or an HMO
- Extensive knowledge of Department of Defense TRICARE and Veteran's Health Care Programs preferred
- Recent experience managing physicians
- Demonstrated success in managing health care costs, medical trends, utilization management and quality management
- Minimum five years experience supervising (directly and indirectly) director level and above leaders
- Sound clinical knowledge and experience
- Knowledge and understanding of the health care industry, managed care, health plan operations and local delivery systems
- Solid understanding of managed care in fee for service, capitated and accountable care organization delivery models
- Ability to lead and participate on cross-functional integrated teams in a matrixed organization and participate as the clinical/medical leader in the senior leadership/management team of the business units
- Demonstrated analytical skills, both strategic and tactical
- Excellent ability to prioritize, set and achieve objectives
- Demonstrated ability to interface with market, line of business and functional leaders to accomplish objectives
- Excellent judgment with the ability to make timely and well-informed executive decisions
- Strong ability to use various influence strategies and collaboration skills, with both internal and external stakeholders
- Ability to build and lead teams
- Excellent leader with ability to assess, recruit and coach
- Ability to develop and maintain strategic networks
- Excellent communication skills (presentation, written and verbal)
- Ability to travel
Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.
The following section describes the general physical requirements for this position. Please note that 'constant' refers to more than 81% of time; 'significant' refers to 40-80%; and 'moderate' refers to 20-40% of the time.
Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening.
- Operates personal computers, printers, facsimile, telephones, copy machines and other commonly used office accessories/equipment.
- Exposed to confidential information and expected to maintain confidentiality at all times; must adhere to HIPAA rules and regulations.
- May be required to work outside of normally scheduled hours as mandated by the client, project and/or workload (e.g. evenings, weekends, and/or holidays).
- May be required to maintain established work pace, meet deadlines; may have last minute urgent requests.
- Physical activity may include: twisting, reaching, kneeling, bending, stooping, squatting, crawling, grasping, grabbing, pushing, pulling, repetitive motion, climbing, etc.
- Required to have visual acuity to determine the accuracy, neatness, and thoroughness of the work assigned.
- Required to have hearing ability to receive detailed information through oral communication.
- Required to have speaking ability to express or exchange ideas.
- Constant concentration may be required on various subjects by listening, reading and thinking clearly.
- Interaction with others may be required. May need to listen, think, and speak in order to interact with others. Business interactions and behavior between coworkers and/or external customers are required. This may require face-to-face or telephone interactions.
- Thinking at work may include listening, learning, analyzing, evaluating, and the ability to interpret what is seen and/or heard, or to link information from one issue to the next.
- Constant computer usage including typing and/or eye strain.
- Constant repetitive arm, wrist, hand and finger motions -- making repetitive movements (e.g. key boarding, filing, data entry).
- Significant phone usage; headsets may be required.
may be required between work sites and/or out of area.
- Moderate lifting may be required.
May need to lift, carry and/or move equipment/supplies weighing up to
pounds, always using safe lifting techniques.
- Constant amount of time spent working in a loud office environment with frequent interruptions/distractions.
- Constant sedentary work (desk bound or seated).
- Constant reading is required via computer screen and/or bound printed materials.
Health Net and its subsidiaries are an Equal opportunity/Affirmative Action Employer M/F/V/D.