TEMPORARY Medical Director

Why Choose Jefferson Health Plans?

We are an award-winning, not-for-profit health maintenance organization offering Medicaid, Medicare, and Children’s Health Insurance Program (CHIP) plans that include special benefits to improve the health and wellness of our members. We are committed to creating a community where everyone belongs, acknowledges, and celebrates diversity and has opportunities to grow to their fullest potential.

While this job currently provides a flexible remote option, due to in-office meetings, training as required, or other business needs, our employees are to be residents of PA or the nearby states of DE or NJ.

Perks of JHP and why you will love it here:

• Competitive Compensation Packages, including 401(k) Savings Plan with Company Match and Profit Sharing 
• Flextime and Work-at-Home Options
• Benefits & Wellness Program including generous Time Off 
• Impact on the communities we service 

We are seeking a talented and enthusiastic Temporary Medical Director - NICU to join our team! 

Function as an integral part of the HealthCare Management team responsible for Asses the feasibility of developing a comprehensive NICU program that will start at conception and complete 1 year post NICU discharge. Represent HealthCare Management in interdepartmental activities and represent Health Partners in the hospital/health system and provider communities and regulatory and governmental activities.  Apply clinical expertise and experience as a provider to promote the proper delivery of medically necessary services to the population served.  Perform utilization, pharmacy, and quality reviews. 

As the Temporary Medical Director - NICU, your daily duties may include: 

• Perform Assessment:
  • Request and analyze appropriate NICU data
  • Guide review of contract language with contracting team
  • Recommend structure of team and overall program activities
  • Analyze savings opportunity with clinical analytics team.
• Advise the HealthCare Senior Management team regarding the utilization of health care services and interventions to promote the effective delivery of medically necessary services: 
• • Pre-natal care
  • Notification on admission to the NICU
  • Evaluations of short stays
  • Review days for appropriate leveling of care
  • Review days for delays in procedures, surgeries, testing or discharge
  • Post 1 year case management follow up
  • Claims review team which will handle all NICU claims
  • Recommend development and structure of a NICU dashboard

• • Recommend cadence and structure of NICU Rounds

• Develop and implement policies and procedures required to promote effective utilization management and achieve established targets.
• Collaborate with HealthCare Economics and Finance to continuously improve the collection and use of data describing resource utilization and outcomes. 
• Develop and implement work plans to optimize appropriate utilization and quality targets as directed by the VP Chief Medical Officer.
• Perform other job duties as assigned.

Qualifications

• Medical Physician (MD or DO) required.  
• Pennsylvania Medical License without restriction.
• Board Certification in a specialty (primary care preferred)
• Graduate business degree is a plus (MBA, MMM, etc.). 
• Minimum 5 years post-residency experience in the clinical practice of medicine.
• Managed care experience, with responsibility for utilization management.

Skills we value:

• Excellent organizational, interpersonal, time management and communications skills. 
• Strong leadership skills. 
• Strong conflict resolution and independent decision-making skills.
• Expert project management ability. 
• Strong influencing, negotiation and analytical skills. 
• Working knowledge of PC based applications such as Excel, Access and Word.
• Knowledge of the principles of Utilization, Quality and Care Management.