This position partners with the business leaders in the Accountable Care Organization (ACO) and Health Maintenance Organization (HMO) areas to develop, implement and partner with other organizations for the creation of successful ventures for Children's Health System of Texas (CHST). This will include interactions with third-party payers, other health systems, Health and Human Services, Texas Department of Insurance and major employers. The interactions and initiatives will cross both the value-based contracting as well as the fee-for-service (traditional) areas of the hospital and health system.
Will provide medical leadership for the provider-based insurance and managed care functions and, in so doing, serve as the primary medical interface with external third-party payors, government agencies, hospital, third-party administrators, brokers and employers.
Will be a clinical change agent and champion for change with the Children's and UTSW pediatric clinical environments, as well as in the external environment.
- Typically provides leadership through multiple layers of subordinate managers
- Accountable for the financial and operational performance of a function or multiple related functions
- Communicates a compelling vision for the future of the function in the context of Children's strategies and mission
- Develops strategies for the function that are aligned with Children's mission and strategy; provides input as needed, to strategy and long-term planning of Children's
- Establishes metrics within the function and oversees execution of strategies to achieve key organizational objectives
- Makes decisions regarding budget allocation within own area of responsibility and influences the allocation of resources across multiple functions
- Is accountable for decisions that have significant impact on financial or operational performance of more than one function
- Serves as a change champion for key organizational initiatives, including initiatives that are outside their own area of responsibility
- Accountable to the Board of Directors
Essential Duties and Responsibilities
- The Medical Director will provide physician leadership for discussions, continuing education initiatives, demonstration projects for managed care utilization, care, and disease management and quality. Additionally provide medical leadership for the medical management of CMCHP members.
- In partnership with key leaders, facilitate and participate in negotiating population-based contracts with employers, government contractors, payors and accountable care organizations. The Medical Director will simultaneously serve as the primary physician resource for providers in negotiation/education of risk arrangements and new strategic alliances.
- In conjunction with the executive leadership of Children's Medical Center, UTSW Division Directors, the Chief Clinical Officer and the VP, Clinical Integrated Networks, the Medical Director will support the development and implementation of an integrated care delivery system across community-based provider settings, UTSW specialty and subspecialty settings, and Children's Medical Center settings.
- The Medical Director will provide physician leadership for discussions, continuing education initiatives, demonstration projects and new ventures with third-party payors and employers. As an example, provide medical leadership for innovative health improvement initiatives for employer groups. Additionally provide medical leadership for the medical home and pay-for-performance demonstration projects with third-party payors.
- In conjunction with the leadership of Children's and UTSW, build formal alliances and ventures with integrated health care systems, adult hospitals and adult accountable care organizations, positioning Children's as the preferred pediatric referral destination of choice for children with complex illnesses.
- Build positive, productive personal and professional relationships with external affiliates and UTSW physician leaders.
- Four-year Bachelor's degree or equivalent experience required.
- Graduate or professional work or advanced degree; or equivalent experience preferred.
LICENSES and CERTIFICATIONS:
- Medical license to practice in Texas required.
- Board certification in pediatrics or a pediatric subspecialty preferred.
- Minimum of 7 years of administrative leadership experience in addition to clinical practice, in healthcare financing and delivery organizations, providing medical leadership for third-party contract negotiation, risk-sharing payment arrangements, and business development required.
- Full comprehension of Managed Care Utilization Management practices, guidelines, and protocols required.
- Full comprehension of hospital and provider reimbursement, both in fee-for-service, government based contracts, and value based contracting required.
Specific knowledge, skills and abilities
- Maintain effectiveness when experiencing major changes in work responsibilities or environment; adjust effectively to work within new work structures, processes, requirements, or cultures.
- Use appropriate interpersonal styles to establish effective relationships with customers and internal partners; interact with others in a way that promotes openness and trust and gives them confidence in one's intentions.
- Meet patient and patient family needs; take responsibility for a patient's safety, satisfaction, and clinical outcomes; use appropriate interpersonal techniques to resolve difficult patient situations and regain patient confidence.
- Translate strategic priorities into operational reality; align communication, accountabilities, resource capabilities, internal processes, and ongoing measurement systems to ensure that strategic priorities yield measureable and sustainable results.
- Identify and drive organizational and cultural changes needed to adapt strategically to changing market demands, technology, and internal initiatives; catalyze new approaches to improve results by transforming organizational culture, systems, or products/services.
- Establish and commit to a long-term business direction after considering clinical and financial data, resources, market drivers, and organizational values; anticipate and respond to shifts within the market, technology, or policy environment that influence the delivery, management, and financing of healthcare.
- Vividly communicate a compelling view of the future state in a way that helps others understand and feel how business outcomes will be different when the vision and values become a reality.
- Provides feedback, instruction, and development guidance to help others excel in their current or future job responsibilities; plan and support the development of individual skills and abilities.
- Interact with others in a way that gives them confidence in one's intentions and those of the organization.
- Demonstrate a poised, credible, and confident demeanor that reassures others and commands respect; convey and image that is consistent with the organization's vision and values.
- Clearly and succinctly convey information and ideas to individuals and groups; communicate in a focused and compelling way that captures and holds others' attention.
Children’s Health is an Equal Opportunity / Affirmative Action Employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, sex, sexual orientation, gender identity, protected veteran status or disability.