The Senior Care Option (SCO) Medical Director (MD), Geriatrician is the lead clinician and, in collaboration with the Chief Clinical Officer (CCO), is responsible for the over-arching model of care (MOC) for SCO members. The MD oversees the clinical assessment process, development of the individual plan of care and monitoring of the on-going medical/social and behavioral care.  The MD ensures that geriatric principles of medicine are incorporated into the complex, co-morbid conditions and ensures that geriatric risk factors are taken into account during care coordination and care navigation activities.  The MD oversees utilization management, reviews trends, evaluates medical necessity of care/services in some cases, reviews any adverse determinations and ensures that the highest quality of care is delivered.  In addition to the SCO, the Medical Director has oversight for programmatic development of the Long Term Support Services (LTSS).

The MD represents the Office of Clinical Affairs in developing and maintaining relationships with governmental organizations, regulatory groups, healthcare providers, and other external stakeholders.

Key Functions/Responsibilities:

• In collaboration with the CCO and OCA department leadership, develops and executes clinical strategic goals and objectives for SCO. Develops initiatives to support the SCO Model of Care with the goal to improve the health of the population, promote the highest quality and experience of member care, while delivering the most cost effective care and service. 
• As requested by the CCO, leads specific elements of OCA strategic planning and addresses key challenges across the organization such as, but not limited to, strategic planning and development of the LTSS and Care Management (CM) models of care across MA.
• The Medical Director works alongside the utilization and care management teams; evaluating medical necessity of specific medical services for dually eligible and Medicare only members of SCO, LTSS programs within BMCHP and within applicable programs in NH.  The MD reviews all adverse determinations and ensures that the highest quality of care is delivered at the most appropriate service level.
• In collaboration with the CCO and the OCA CM leadership, builds and maintains strong relationships with stakeholders including, but not limited to, the MA Executive Office of Health and Human Services (EOHHS), providers, and member advocacy groups.
• Participates in and chairs clinical committees as requested by the CCO, including the MA Provider Advisory Committee.
• Represents the CCO in MA and other locations as requested.
• Develops and oversees geriatric focused assessments, including development of a full scale dementia and Alzheimer’s program while also attending to the complex co-morbid conditions of the dually eligible population in the SCO and the LTSS programs across the Managed Care Organization (MCO) and Accountable Care Organization (ACO) products.
• Participates in interdisciplinary rounds for members in SCO, LTSS services, Management as necessary. Facilitates care planning, critical thinking and model development. 
• Develops clinical rotations for geriatric fellows as well as geriatric nurse practitioners.
• Develops new programs with special emphasis on end stage renal disease care management/disease management policy.
• Develops a collaborative practice with the Boston Medical Center (BMC) Geriatric Program, including a close affiliation with the multidisciplinary Geriatric Assessment Center and BMC Geriatric Home Care Program.
• Works directly with the Vice President of Product do develop and enhance the SCO and Medicare Products.

Supervision Exercised:

• Will provide clinical expertise and direction to SCO staff through a matrix reporting structure with department leadership.

Supervision Received:

• General direction is received from the CCO and CEO of the Health Plan.

Qualifications:

Education:

• Graduate as a Medical Doctor from an accredited college of medicine is required.
• Geriatric Specialty

Experience:

• 8-10+ years of related experience is required including a minimum of 5 years direct clinical experience and a minimum of 3 years experience in medical management, health plan and/or strategy.

Certification or Conditions of Employment: 

• Board certification in recognized medical specialty
• Unrestricted licensure as an MD in  Massachusetts

Competencies, Skills, and Attributes:

• Passion for performance and process improvement and its link to population health, quality, and total cost of care.
• Distinctive ability to solve complex problems.
• Excellent demonstrated clinical skills and knowledge.
• Flexible, innovative, and creative; willing to share fresh perspectives and new ideas for the full
• continuum of care.
• Exceptional ability to communicate and present complex concepts to a wide variety of audiences.
• High-integrity leadership with team orientation.  Ability to manage through uncertainty and complexity.
• Results-driven with a keen ability to influence others and build trusting relationships
• Ability to manage staff in a matrix organization, balancing local needs of Well Sense office with the departmental and other needs within OCA.
• Experience in New Hampshire preferred.
• Health plan and/or provider administrative experience preferred.

Working Conditions and Physical Effort:

• Ability to travel to locations within New Hampshire and Massachusetts on an as needed basis.

*Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.