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Cape Cod Healthcare

Hyannis, MA
Job Code:
  • Healthcare
  • Management
  • Administrative / Clerical
Cape Cod Healthcare
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Job Details

MEDICAL DIRECTOR-180317-50007627
Reporting to the Senior Vice President of Managed Care, serves as the Medical Director of Cape Cod Healthcare ACO (the “PHO”), Cape Cod Preferred Physicians, LLC (the “Physician Organization” or “PO”), and the Cape Cod Healthcare Employee Health Plan (the “EHP”).
  • Works closely with the Senior Vice President of Managed Care to maximize PHO’s performance on cost, quality, patient experience and clinical integration in order to facilitate the attainment of favorable finance results under risk and P4P contracts with third-party payers;
  • As a physician leader, facilitates culture change among PO/PHO physician members including adoption of value-based and patient-centered principles and related care delivery/practice innovations;
  • Serves as the single most authoritative resource within the PHO with respect to clinical matters;
  • Works with applicable PO and PHO committees in the development and ongoing maintenance of clinical care guidelines;
  • Directs risk coding initiatives, educates PHO providers and directly supervises PHO coding staff;
  • Actively manages referrals for members of applicable risk plans and works directly with PHO referring physicians in order to retain business in network in support of clinical integration objectives while directly supervising PHO referral support staff;
  • Educates PHO quality staff and PHO providers with respect to quality/patient experience metrics and related performance initiatives;
  • Assists PHO clinical management with the development, implementation and ongoing management of case management and care coordination models, initiatives, workflows and systems;
  • Represents the PHO as medical director to the Steward Health Care Network (“SHCN”), Medical Management Committee and other such committees as may be reasonably assigned;
  • Serves as committee member and/or chairs the following PO and PHO Committees: Clinical Integration, Quality, Opioid, Medicaid ACO Steering, Behavioral Health, and others as reasonably assigned;
  • Directs and serves as lead presenter in various PO/PHO provider meetings, including but not limited to: monthly PCP POD meetings, Specialist POD meetings, Pediatric POD meetings, and PO membership meetings;
  • Provides support and input on the PHO’s Distribution Model including the development and refinement of performance metrics
  • Working collaboratively with the Senior Vice President of Human Resources and Director of Employee Benefits, Health and Wellness, strives to improve overall health of members by developing, monitoring and refining wellness and disease management strategies, programs, and initiatives;
  • Assesses effectiveness of utilization and referral management policies and processes and makes recommendations for improvement where appropriate;
  • Monitors referral and utilization patterns, and reports on outcomes and effectiveness, including recommendations for action needed;
  • Works collaboratively with the third-party administrator of the EHP and benefit consultants to ensure a high level of both quality and effectiveness of the overall medical benefits program;
  • Keeps abreast of new trends, tools, and programs to engage members in management of their health and works with Human Resources on member education and wellness programs;
  • Assists in lowering Cape Cod Healthcare’s overall and per member medical/benefit expenses and expenditures;
  • Devises and makes recommendations as to effective strategies for population health management activities and initiatives;
  • Attends all meetings reasonably assigned, including Self-Insurance meetings and other scheduled meetings with employee stakeholders;
  • Performs other related duties as reasonably assigned.
Consistently provides service excellence to all patients, family members, visitors, volunteers and co-workers in a manner that reflects Cape Cod Healthcare’s commitment to CARES: compassion, accountability, respect, excellence and service.

  • Currently practicing licensed physician in Massachusetts with a minimum of 5 years clinical experience;
  • Board certified in internal medicine, pediatrics, or family medicine;
  • Conversant in the principles of – and latest trends in – clinical integration and value-based care;
  • In-depth knowledge of applicable state, federal, and third-party regulations;
  • Experience with NCQA, HEDIS, Medicaid, Medicare, and pharmacy benefit management; managed healthcare systems, quality improvement, medical utilizations management, risk management, risk adjustment, disease management and evidence-based guidelines;
  • Must be a collaborative contributor with the ability to work in a team environment; ability to clearly communicate information, educate, and build consensus; ability to present information and interact effectively and positively with a diverse range of constituents;
  • Demonstrated leadership skills with ability to engage, motivate and develop others;
  • Analytical skills to collect and synthesize information in order to solve problems; accuracy and attention to detail required;
  • Ability to function effectively within a fast-paced ever-changing environment, demonstrating nimbleness and flexibility to meet deadlines and reprioritize as necessary;
  • Creative, flexible, self-motivated professional who possesses sound judgment;
  • Must be able to maintain information in a confidential manner according to policy;
  • Proficient in all applicable MS Office applications.
Please submit your resume and application to:
Mick Ruel
Vice President, Senior Executive Search
(913) 752-4595

Schedule Details: Monday-Friday; Day Shift; Occasional Weekends Holidays
Organization: Cape Cod Healthcare, Inc.
Primary Location: Hyannis
Department: HCI-PO - PHO
Employee Classification: Regular-Regular
Shift: Day
Weekend Shifts: Occasional
Holiday Shifts: Occasional
Posting Start Date: Mar 21, 2018
Posting End Date: Ongoing
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