Affinity Health Plan Inc Bronx , NY 10451
Posted 3 weeks ago
PURPOSE OF THE POSITION:
Assures the competence and soundness of Affinity's service delivery program by providing professional expertise (i.e., guidance, advice, decisions, actions and judgments) to all areas of the organization including, but not limited to, Care Delivery operations, regulatory affairs, corporate compliance and quality improvement. This position also assists the Chief Medical Officer in articulating Affinity's health care vision and medical management model, and in establishing clinical policies, practices, standards and programs that are a) coherent and internally consistent, b) comply with relevant laws, rules, regulations and professional standards, and c) contribute to achievement of corporate strategies, goals and objectives, and fulfillment of the corporate mission and vision.
ESSENTIAL FUNCTIONS:
1.Provides professional expertise and services that support the Care Delivery Division, including, but not limited to, the following.
a) Utilization management:
b) Credentialing:
c) Provider network:
d) Quality management and related initiatives:
2.Provides professional advice, guidance and support to other operational, analytical and strategic activities of the company, including, but not limited to, marketing, member services, claims, and public affairs.
3.Represents Affinity on appropriate local, State, and national trade groups, governmental and industry workgroups and committees and similar external venues; seeks opportunities to report on Affinity's projects and programs.
4.Develops and maintains positive, constructive, mutually beneficial relationships that promote Affinity's goal of being the "health plan of choice" for providers, consumers and purchasers.
QUALIFICATIONS:
1.License to practice medicine in New York State.
2.Board Certification in a primary care specialty.
3.Minimum of three(3) years of experience as an associate medical director or medical director working with utilization management, peer review, network assessment and provider relations, and quality improvement, preferably in an HMO environment. Working knowledge of clinical protocols, utilization review standards, and professional credentialing standards, policies and procedures.
4.Minimum of five (5) years of clinical practice experience, preferably serving an urban population.
5.General and managed care business knowledge demonstrated by:
6.Management, consultative and process skills required to initiate, implement and complete tasks and responsibilities in a timely manner, and to promote coordination of activities across departments or divisions.
7.Highly developed interpersonal and management skills, characterized by the ability to persuade, listen, interpret, negotiate, mediate, mentor, teach, consult and advise inside and outside of the organization, and to manage critical internal and external relationships.
8.Good judgment in a) seeking and using information to support decision making, b) anticipating the consequences of decisions and actions, c) communicating information, d) interacting constructively with others inside and outside the organization, e) maintaining confidentiality as appropriate, and f) choosing actions that are beneficial to, and consistent with the mission, goals, culture and style of the organization.
9.Ability to consult, advise and influence others in the absence of formal authority or direct reporting relationships.
Organizational skills demonstrated by the ability to anticipate needs, to prepare appropriately and to organize and complete work efficiently and effectively.
Strong analytical skills, demonstrated by ability to identify and use qualitative and quantitative clinical and operational information and data to identify needs, select among competing approaches, make decisions, set priorities and monitor progress towards goals and objectives and desired outcomes.
Excellent writing and verbal communication skills characterized by the ability to articulate complex concepts and quantitative and qualitative information to diverse audiences.
Enthusiastic understanding and commitment to the corporate mission, vision, and values; understanding of, and sensitivity to, the needs, behaviors and expectations of a culturally diverse Member and provider population.
Demonstrated integrity, trustworthiness, respect for others, and ability to deal appropriately with confidential and sensitive information.
Affinity Health Plan Inc