Senior Medical Director

Arizona Priority Care (AZPC) is an Integrated Provider Network focused on providing Whole-Person Care to Senior and Medicaid populations, through advanced value-based models. Our provider network is comprised of more than 3,500 providers including Primary Care, Specialty, Hospital System and ancillary provider partnerships. We have operated in the Arizona market for more than 10 years, and are based in Chandler, Arizona. As a leading value-based provider organization, we are committed to improving the quality of care, providing excellent member and provider experiences all while reducing costs.

The Senior Medical Director’s goal is to create a seamless environment where the clinical aspects of care delivery (i.e. PCP’s Specialists, Ancillary) and the traditional “health plan” administrative functions complement each other in a care delivery model that avoids unnecessary hospital admissions and readmissions, and promotes safe definitive care in the outpatient setting. This role has two distinct aspects (clinical and administrative) that together facilitate successful outcomes. The Medical Director is a licensed, board certified physician with strong clinical, administrative, and leadership experience. This role has a matrix reporting relationship to the Corporate CMO.

Position Duties

1. 1. Provide clinical expertise, medical interpretation, and decisions about appropriateness of services including, but not limited to: Prior Authorization, Concurrent Review, Retrospective Claims Review, Clinical Practice Guidelines, Preventive Health Guidelines, Medical Technology Assessment, Care Coordination/Management, Disease/Chronic Illness Management, Part B Drug Review, Quality Improvement, Appeals & Grievances, and Transplant Management.
   2. Collaborate with Physician Advisors/Consultants and provide oversight to their review process.
   3. Collaborate with physician leaders on Compliance and Quality (STARS) system initiatives in a manner consistent with medical staff bylaws.
   4. Oversight of administrative functions within Clinical Services: Utilization Management, Care Management, Quality Improvement, Regulatory Compliance and Credentialing.
   5. Provide leadership of strategic medical management activities contributing to performance and promoting quality of care.
   6. Lead, develop, direct, implement, evaluate, and analyze clinical and nonclinical activities that impact cost, quality of care, and health outcomes.
   7. Ensure compliance with clinical goals via the Care Management process including leading the Interdisciplinary Care Team(s), management and assessment of population health needs, and creative management of the social determinants of health that act as barriers for positive health outcomes.
   8. Responsible for all Programs, Policies, and Processes, including the adoption of clinical criteria and medical necessity policies.
   9. Provide guidance, clinical expertise, and business directive in support of all departments within AZPC.
   10. Act as a business leader and clinical liaison for contracted practitioners and organizational providers to support successful execution of programs and quality initiatives.

Education, Training and Experience

• Minimum five years as a licensed, practicing MD or DO.
• At least five years previous experience with, and current working knowledge of, Utilization Management concepts, and prior authorization and concurrent review processes and workflow.
• Minimum of three years management experience preferred with demonstrated excellent communication, attention to detail and problem solving skills.
• Knowledge of managed care systems, NCQA, and CMS standards.
• Excellent knowledge of computer applications, including Word, Excel, Outlook, Power Point.
• Excellent customer service etiquette skills, orally and in writing.
• Excellent interpersonal skills.
• Demonstrated ability to work within a team environment and creatively lead staff to achieve organizational goals.