Mercy Medical Group, Inc. is a growing 460 provider multi-specialty group in the Sacramento metro area with 26 total sites, and 36 specialties represented. The medical group has been affiliated with Dignity Health Medical Foundation as a contracted partner for over 20 years. The medical group provides both outpatient and inpatient services to support the four Dignity Health hospitals in the Sacramento area. Approximately 30 percent of revenues for the group and the foundation partner are related to capitated managed care contracts. Additionally another percentage is related to other risk-based contracts such as ACOs. Population health management is increasingly important for the success of the group and our foundation partner including improving ambulatory quality metrics, transitions of care, complex case management, and utilization management. Additionally, the group performs very well on HCC documentation and coding requirements.
The Care Management portion of the position is responsible for medical oversight and coordination-of-care and overall team performance related to services rendered to complex managed care and fee-for-service patients who have primary care providers at Mercy Medical Group (MMG). Additionally, the position is responsible for oversight of ambulatory and other quality metrics (IHA P4P, MIPS/MACRA, Meaningful Use, GPRO, etc.), as well as for strategies related the team-based approach to complex patient management and transitions of care for these patient. This position will work in conjunction with the care management functions of Dignity Health and Dignity Health Medical Foundation and will also take direction from Dignity Health’s medical leadership over care management.
The Utilization Management portion of the position is responsible for medical oversight of covered health services rendered to Mercy Medical Group (MMG), and assigned HMO members. Additionally, the position is responsible for medical oversight for other risk-based contracts with health plans and employers including ACO contracts and other innovative risk-based contracts. The focus of this position is cost-containment, appropriateness and quality of medical services. The position is also responsible for compliance and reporting and other delegated responsibilities for the risk-based contracts.
This significant leadership position reports to the Chief Medical Officer and works closely with DHMF Chief Administrative Officer and Utilization Review Manager. This position gives direction to the Utilization Review Manager and all other staff as relates to medical clinical issues related to care provided by MMG providers. This position has no direct reports.
EXPERIENCE AND QUALIFICATIONS
Medical degree with appropriate Board certification
Medical licensure in CA (or ability to obtain CA licensure)
At least 5 years of clinical practice experience
2 years of experience with managed care, including utilization management; relevant experience in CA strongly preferred
Demonstrated ability to influence physician behavior
Strong interpersonal, public speaking and communication skills
Employer will assist with relocation costs.
Additional Salary Information: Competitive compensation and benefits package commensurate with experience
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