Role overview

The Medical Director, Care Management leads the care, case, and utilization management programs, setting clinical direction and owning program performance for Included Health's CCM and UM programs.

This physician leader is first a strong operator. The person owns outcomes, not just clinical standards, with success defined as the program hitting its performance and quality targets. This role owns a critical program that bends the cost curve: navigating members to high-quality care, educating members about their health, and supporting them during vulnerable moments.

Reporting to the Senior Medical Director, Complex Care, they bring a strong, evidence-based point of view, are comfortable operating under ambiguity, and translate organizational priorities into clinical operations that perform at scale. They are responsible for ensuring the programs contribute to clinical outcomes, client commitments, and third-party oversight. This physician leader leads an innovative, fast-moving team at the core of Included Health’s population health strategy.

 

We are seeking a highly motivated physician who enjoys management of all health conditions and who is passionate about raising the standard of healthcare for everyone. The Physician will be responsible for caring for patients of all ages, maintaining accurate and current patient records, and working collaboratively with our provider and support teams. Start a conversation with us and learn how you can positively impact the lives of patients and play a role in improving healthcare. Medical malpractice insurance coverage is included. 

We are seeking a highly motivated physician who enjoys management of all health conditions and who is passionate about raising the standard of healthcare for everyone. The Physician will be responsible for caring for patients of all ages, maintaining accurate and current patient records, and working collaboratively with our provider and support teams. Start a conversation with us and learn how you can positively impact the lives of patients and play a role in improving healthcare. Medical malpractice insurance coverage is included. 

• Perform age-appropriate history and virtual examinations, evaluate, diagnose, recommend treatment plan and document findings appropriately and timely

• Deliver high quality patient care while maintaining safety

• Document medical information of patients and review patient history at each visit

• Request consultation or referral with other health care providers when appropriate

• Counsel and educate patients

• Order and interpret diagnostic tests as needed

• Evaluate, triage and manage pediatric and adult patients for acute care, and have experience with chronic disease management and mental health conditions.

• Actively maintain knowledge of current medical research and trends

• Scheduling flexibility to include evenings and weekends

• Completion of a 3-year Family Medicine, Internal Medicine, or Emergency Medicine residency

• 3+ years post residency experience in a fast paced Urgent Care or Primary Care outpatient setting

• Active ABMS or AOA Board Certification in Family Medicine or dual boarded Internal Medicine + Pediatrics.

• Completion of U.S. Medical Licensing Examination

• Active and unrestricted state medical license in at least one state (5+ licenses preferred)

• Experience and comfort providing care for all ages, newborn to adult populations

• Ability to function within an integrated medical practice

• Extensive breadth of clinical expertise

• Excellent communication and interpersonal skills

• Demonstrable proficiency with technology

• Demonstrate flexibility

• Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an “excluded person” by the Office of Inspector General of the Department of Health and Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare

• Must maintain Medicare active status

• Multistate licensure (5+ licenses preferred)

  • Prefer candidates with licenses in GA, AL, TN, MO, SC, IN, OK, MS 

• Telemedicine or virtual care experience with video based visits 

• Experience with Athena EMR 

• Experience and interest in supervising Nurse Practitioners

• Recommend a minimum of 25% of prescheduled time on weekends. Recommend a minimum 25% of prescheduled time after 5p local time zone.

• Minimum of 8 scheduled hours required every quarter to stay active as an IH Direct IC.

• Prescheduling for higher per visit rates is not guaranteed and will depend on IH business needs.

  • Set schedule 30 days in advance with potential to join additional ad hoc shifts. Schedules finalized 7 days before the start of the month. 

  • Expectation of 90% schedule adherence.

• Prompt and regular attendance at assigned work location.

• Ability to remain seated in a stationary position for prolonged periods.

• Requires eye-hand coordination and manual dexterity sufficient to operate keyboard, computer and other office-related equipment.

• No heavy lifting is expected, though occasional exertion of about 20 lbs. of force (e.g., lifting a computer / laptop) may be required.

• Ability to interact with leadership, employees, and members in an appropriate manner.

We're seeking board certified Nurse Practitioners with broad clinical expertise and a passion for improving healthcare access and quality. In this role, you'll deliver virtual comprehensive care to patients of all ages across a wide range of conditions, while working closely with our provider and support teams. This is a great opportunity for a clinician with at least 3 years experience in high-volume Urgent Care or Primary Care settings. Medical malpractice insurance coverage is included. 

This role will report to the Urgent Care Manager. Physician supervision will be provided in states that require collaborative agreement.

Currently unable to consider candidates residing in the following states: AL, IN, GA, MN, MS, MO, OK, SC, or TN

We are seeking a highly motivated physician who enjoys management of all health conditions and who is passionate about raising the standard of healthcare for everyone. The Physician will be responsible for caring for patients of all ages, maintaining accurate and current patient records, and working collaboratively with our provider and support teams. Start a conversation with us and learn how you can positively impact the lives of patients and play a role in improving healthcare. Medical malpractice insurance coverage is included. 

• Your primary objective is to provide effective and timely customer service for members, providers, insurers and clients regarding health care claims

• Ensure timely follow-up on requests for accounts to be reviewed

• Organize health insurance paperwork and medical record documentation

• Demonstrate knowledge of proprietary software and other required technology (Google apps, Slack, etc)

• Communicate timely status updates to patients throughout the claims process

• Negotiate with providers on plan member balances

• Appeal claim denials from the insurance company

• Contact providers and insurance companies to resolve claim concerns

• Assist with understanding of explanation of benefits (EOBs)

• Assisting members with resolving claim errors or denials. Ideally to recoup or lower their medical expenses

• Collaborate with peers and management across functions

• Understand the evolving business requirements and adapt the operational processes to meet those requirements

• Speak clearly, confidently and maintain professionalism as well as friendly member interactions while demonstrating persuasion in overcoming objections

• Ability to handle a fast-paced, dynamic environment with competing priorities

• Model a culture reflective of our core company values 

• Gain and retain a thorough understanding of the team and company policies, processes, software, etc

• Including other duties and responsibilities as assigned by leadership