The IHC Quality Medical Director (QMD) will work with the Network President to oversee the quality, safety, efficiency and effectiveness of the medical care provided by the IHC and its participants. The QMD serves as the primary clinical leader and policy advisor to the company and IHC President and as the primary support of the Performance Improvement and Quality Committee.
The QMD is accountable for and provides professional leadership and direction to the utilization/cost management and clinical quality management functions of the Network. He/she works collaboratively with Aultman Health Foundation (AHF) and other participating hospital functions that interface with the Network medical management such as case management and care coordination programs. The QMD also assists the IHC President and management team in short and long range program planning, total quality management (quality improvement) and external relationships, including those related to the Midwest Health Collaborative (MHC). He/she is accountable for the reporting of the scorecard metrics to both the Board and the physicians of the IHC. He/she also will work collaboratively with the AHF Chief Quality Officer and the AHF Quality Department for support, assistance and strategy in overall clinical improvements, develop policies as needed for the IHC in the area of clinical quality and cost effectiveness and keep current on national standards and innovations in clinical care.
The QMD is responsible and accountable to the IHC President for helping to manage Network medical costs and assuring appropriate health care delivery for IHC’s contracts and services. The QMD reports to the President of IHC.
RESPONSIBILITIES & EXPECTATIONS
Supports the Performance Improvement & Quality Committee.
Participates in the design and implementation of IHC policies and goals and objectives related to clinical care and cost efficiency, including primary and specialty services for in-patient, out-patient, preventive care and wellness programs and disease management programs.
In collaboration with the Performance Improvement and Quality Committee and the PIQC Chair, leads the IHC in developing a scorecard of relevant metrics and goals to improve the health of the community at the lowest cost. The scorecard metrics and goals will be reviewed by the Board on a quarterly basis and updated annually.
Leads the design and development of the care improvement initiatives, through the organization and management of specific task forces or collaboratives charged with recommending IHC Clinical Care Guidelines, Protocols and Metrics for tracking improvements.
Provides professional leadership and direction to the functions within the Care Management Department of IHC (Utilization/Cost Management and Clinical Quality Management).
Assures plan conformance with legal and regulatory requirements.
Assists the Performance Improvement and Quality Committee in creating and maintaining a system that gives feedback to providers individually and collectively regarding managed care effectiveness.
Assists the Credentialing and Professional Standards Committee in designing and implementing corrective action plans to address issues and improve plan and network managed care performance.
Collaborates with Board, Performance Improvement Committee and the IHC President in creating and maintaining programs that incentivize providers to achieve selected utilization/cost and quality outcomes.
Participates in policy review, performs analysis and makes recommendations related to clinical and efficiency improvements.
Performs and oversees training and education of professional staff in the IHC Clinical Quality Department.
Participates in IHC risk management, pharmacy utilization management, catastrophic case review, outreach programs, HEDIS reporting, provider orientation, credentialing, profiling, etc.
Assists the President in monitoring participant satisfaction survey results and implements changes as needed to increase satisfaction and assure that satisfactory relationships are maintained between network and participants.
Assists the Primary Care Collaborative and the primary care leadership in Patient Centered Medical Home certification activities; assists practices in preparing for site visits and responds to accrediting and regulatory agency feedback.
Participates in the design and implementation of MHC policies and goals and objectives related to clinical care and cost efficiency, including primary and specialty services for in-patient, out-patient, preventive care and wellness programs and disease management programs.
Performs other duties as requested or assigned.
Unrestricted License in Ohio as a Doctor of Medicine or a Doctor of Osteopathy.
Board Certified as recognized by the American Board of Medical Specialists (ABMS).
At least 5 years of experience in clinical practice
Training or experience in quality management, utilization management, or process improvement
Demonstrated ability to work collaboratively with physicians, staff, and administrators
Strong ability to interact with physicians in the private practice and in employed medical groups through verbal and written communication
Demonstrated ability to analyze and interpret data
Employer will assist with relocation costs.
Additional Salary Information: Salary is base on years of experience, and how much time is spent between medical practice and administrative duties.
Internal Number: N/A
About Integrated Health Collaborative
IHC is an Accountable Care Organization (ACO) formed in December 2013. ACOs are groups of doctors, hospitals and other healthcare providers who come together voluntarily to give coordinated, high quality care to patients.
Integrated Health Collaborative members include:
•Nearly 400 doctors
•Aultman Orrville Hospital
•Aultman Alliance Community Hospital
IHC also partners with local agencies, skilled nursing facilities, rehabilitation facilities and others to help meet your health care needs.
Together we can work to improve your health care! By using a team approach, our goal is to help guide you through the health care system and make it easier for you to get the care you need when you need it. We are committed to assisting you in meeting your health care goals by providing the highest quality of care at the lowest cost.