MLTC-Medical Director

Job Locations US-NY-Bronx
ID
2019-3119
Category
Quality Management
Position Type
Regular Full-Time

Overview

RiverSpring Health Plans, formerly known as ElderServe Health, is seeking a full time Medical Director. Our programs include a Managed Long Term Care program (MLTC), Fully Integrated Dual Advantage (FIDA) program, Institutional Special Needs Program (I-SNP) and Medicare Advantage Plus program (MAP).  Collectively, RiverSpring Health Plans helps care for 18,000 members.

 

The majority of our members are frail, medically complex elderly people whom we try to keep as well as possible for as long as possible.  We focus on personalized assessment and treatment plans which are tailored to the needs of the individual member.  We seek to improve functioning, reduce hospitalization, keep people in their homes and increase satisfaction through compassionate caring, high quality care and innovation to accommodate individual differences and preferences.

 

Responsibilities

The Medical Director works with an interdisciplinary team of administrative and clinical staff who are highly experienced in the care of the frail elderly and disabled individuals to develop care plans and guidelines and assess quality. They are responsible for assuring that the medical care provided to the members meet the current standards of care and is consistent with individual member needs and wishes. 

 

Duties and responsibilities:

 

  • The Medical Director is responsible for the quality assurance program. He/she chairs the Quality Assurance Committee, appoints its members and sets the agenda.
  • Responsible to identify opportunities for improvement and lead the development of projects to improve health outcomes. He/she chairs the Medical Advisory Committee which suggests and evaluates clinical practice recommendations.  
  • Develops policies and procedures related to care, develops practice guidelines and describes their appropriate use, assures compliance with state and federal regulatory requirements for medical care, participates in the training and education of staff, and reviews and discusses problematic cases with physicians, nurses, nurse care managers and other providers to change and improve treatment plans.  EOE

Qualifications

The ideal candidate must possess a current NYS license and registration; MD degree from an accredited medical school; Board Certification  (Internal Medicine a plus); familiarity with Medicare and Medicaid regulatory and reporting requirements; experience in a medical/healthcare management capacity, and good verbal and written communication skills.

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