Senior Medical Officer - Nephrology

Company: Landmark Health
Location: Santa Ana
Posted on: November 14, 2020

Job Description:

Senior Medical Officer will serve as a key member of the management team and report directly to the Chief Clinical Officer driving Landmark’s kidney care programs. He/she will work closely with the respective CCO, having primary responsibility to provide clinical direction and manage Landmark’s kidney care initiatives in order to further growth, ensure high quality patient care, excellence in client relations and meeting of all financial, operational, and quality metrics.

• Lead as an active and hands-on member of the management team to plan and execute adjustments to the clinical delivery model and operations to meet changing needs

• Works with the Chief Clinical Officers, Regional Medical Directors, VP of Clinical Operations, Chief Operating Officer, to set utilization goals, operational and quality metrics, and oversees clinical metrics for kidney care programs

• Participate in the development of budgets, staffing plans, medical loss ratio projections, and assuring the adequate allocation of resources to kidney care medical management functions

• Develop kidney care clinical programs focused on delaying progression of CKD, ensuring proper goal setting and shared decision-making conversations regarding various potential renal replacement therapies and/or kidney transplantation, oversee medical management, and drive quality improvement efforts. Provide leadership, direction, and administration of clinical operations to ensure compliance with Landmark objectives towards the realization of quality, cost-effective health care services

• Builds and maintains positive relationships with health plan business and operational counterparts.

• Lead in areas of utilization management, clinical quality improvement, case management, provider relations, concurrent review, and disease management

• Oversee risk management, pharmacy utilization management, catastrophic case review, outreach programs, HEDIS reporting, site visit review coordination, triage, provider orientation, and credentialing

• Implement and monitor structures and processes which are measurable and flex/change those processes as needed to meet financial, operational, and quality goals

• Participate actively in provider recruitment and oversee in-service staff training and education for professional staff

• Maintain up-to-date knowledge of new information and technologies in PC medicine and their application to the patient population

• Develops relationship with pharmacy directors to ensure LH providers are proper dosing of new and existing medications, de-escalation of nephrotoxic drugs, and cost effective alternatives to non-formulary medications (where appropriate).

• Must possess in depth knowledge and experience working within and/or in partnership with community nephrologist and dialysis centers

• Strong Internal Medicine, nephrology, and comfort caring for highly complex patient populations

• Passion for use of home-based renal replacement therapies (PD or HHD) and/or transplantation for eligible patients.

• Must possess leadership and people management skills and have successfully demonstrated the ability to build and develop a strong medical management team

• Previous leadership experience in either a fully delegated medical model or in a health plan with a complex care delivery model

• Expertise in either delegated risk models or working under cap structures with a strong focus on metrics and quality indicators

• Deep experience in informatics and analytics

• Experience in quality assurance, utilization review, and program development coupled with strong implementation skills

• Degree from an accredited medical school with Board Certification or Board Eligibility, preferably in the clinical specialty of primary care. Subspecialty boarded in Nephrology. Unrestricted license to practice medicine.

• Experience developing and managing clinical programs, focused on the chronically ill and managing medical expense

• Ten (10) years of clinical / management experience preferred in health care.

Keywords: Landmark Health, Santa Ana , Senior Medical Officer - Nephrology, Other , Santa Ana, California