Associate Medical Director (Health Plan)

Waltham, MA
Clinical Operations
A bit about us: 

We’re on a mission to change healthcare — how it’s paid for, delivered, experienced. We want to put people center stage, not process or profit. We are guided by a deep belief that every person on Medicare should be treated like we would treat a member of our own family: with loving care and a profound commitment to their health and well-being. 

That’s why we’re gathering a whole bunch of smart, big-hearted people to create a new kind of healthcare company — one that combines compassion, health insurance, clinical care, and technology seamlessly. 

We want to throw the long ball with people we love for a cause we believe in. Life is short. Join us.

A bit more about this role:

The Associate Medical Director will be a primary clinical leader for Devoted Health Plans which care for all of our members.  Think of this job as the Uber-PCP for several thousand patients. All of these patients have a PCP, some of whom are excellent and others of whom are well-intentioned, under-resourced, and incompletely effective.  Along with a large team of nurses (Clinical Guides), on-the-ground social workers and coaches (Community Guides), pharmacists, quality and coding experts that work at Devoted Health Plan on the Clinical Team and in conjunction with our team of doctors, NPs, and RNs who make house calls in-market called Devoted Medical Group, your job would be simply to make sure that every member gets the care that you would want for a beloved family member.  If we do, we’ll achieve our goals of 5-Stars, appropriate coding, and low total cost of care through reduced unnecessary hospitalization.

Here are the important parts of the job:

Clinical Ambassador ~
You’ll be part of the small team of physician leaders at Devoted.  Part of the job is to meet with PCPs, hospitals, and specialists both here and in-markets.  We can’t do this job without trusting relationships with our providers, so shaking their hands and being available by phone or email is important.  This particular job will not have very much travel, but it may have some occasionally.

Performance Management ~
Part of being a physician leader at a health plan is helping providers take care of their patients.  Mostly, we focus on those providers who are financially at risk, so they’re mostly eager for feedback and input.  Specifically, you’ll work with our Stars team, our risk-adjustment team, and our medical economics team to understand patterns as well as deal with specific patient cases in talking to our providers.  Over time, this part of the role will increasingly move out to the physician leaders who are local.

Utilization Management ~
We have an incredible team of nurses that tackles utilization management with the approach that all providers would want them to take.  We’re actually trying to ensure right care, right place, right time, not trying to save a buck. When the nurses need help with the clinical aspects of a case or finally decide that it isn’t appropriate, you would call the ordering physician.  About half the time, we learn something that helps us understand that the order was reasonable, and the other half, the provider says, “you’re right,” and withdraws the request. We approach these with a lot of humility, and these calls have actually been trust building, uncontentious, learning opportunities for both sides.  Part of this role is also addressing tough cases like transplants, experimental therapies, or difficult hospitalizations.  

Care Management ~
This is the part of the job where, with our team of nurses, pharmacists, and DMG, we figure out how to take great care of our members.  This is high-risk management, helping better control patients with multiple chronic conditions or frailty. It’s better disease management for those with chronic conditions.  It’s management of transitions of care. It’s helping patients at the end of life with advanced care planning and dying with dignity at home or in the ways that feel best to them.  Over time, we want to become exceptionally good at the most difficult to address parts of healthcare for the elderly, behavioral health, chronic pain, addressing the social determinants of health.

Quality and Stars ~
This is both liaising with the Stars team on clinical quality measures and figuring out what quality really means and how we measure and address it.  Chair of the Quality Committee for the Health Plans.

Pharmacy ~
Much of this is working with our pharmacy team to determine the formulary, how we should handle prior authorizations for drugs and step-therapy, and providing clinical input to our pharmacy programs (e.g. adherence, opioids, post-discharge med rec).

This role includes helping create the technology and process so that each one of these gets easier every day.  So often you will have to work with a world-class team of data scientists and computer engineers to serve as a clinical subject matter expert, prioritize and design the technology to support your work, and provide end-user feedback.

Attributes to success:

    • You love clinical medicine, and helping people is what you were born to do
    • You’re a happy warrior - as long as you’re in a great environment with smart, caring people all working together toward a common aim, you’re comfortable working hard
    • You’re wired for learning and change, not being afraid to fail
    • You have a passion for making healthcare better, solving complex problems, and supporting the delivery of healthcare that we would want for our own family members
    • You enjoy a fast-paced, high-energy, growing organization
    • Agility and collaboration are critical to your success - we are a new organization and have a start-up mentality
    • Thinking about the big picture is key for you, but YOU sweat the details
    • You have great clinical and non-clinical judgment

Skills and experience:

    • A physician licensed to practice medicine
    • A practicing primary care physician ideally willing to continue to practice clinical medicine
    • Experience working in interdisciplinary teams
    • An understanding of how different health care payment models work
    • Comfort interfacing with technical teams

Other minor duties:

    • None of these duties take a great deal of time on a regular basis, but they are things to be managed by the health plan physician leadership
    • Credentialing - reviewing credentialing cases, creating policies as needed
    • Clinical Policies - write clinical policies for CMS and for accreditation, as needed
    • Continuity Policies and Decisions - deciding when to allow for out of network coverage, etc. for new members
    • Bid - provide clinical input to the Bid (the process of submitting our benefits to CMS)
    • Model of Care development - working with our team to develop the model of care for special populations like dual-eligible members or members with particular chronic conditions
    • Rewards and Incentives - clinical input to the R&I program
    • Health Risk Assessment - developing the HRA, understanding how to ingest and score, understanding how to utilize it
    • Clinical Vendor Management - making sure we’re working well with suppliers of additional services like palliative care, virtual visits, curbside consults, etc.
    • Clinical Compendia, References - helping to decide what references the clinical team needs to perform their duties
    • Clinical input to the Risk Adjustment team
    • Miscellaneous health plan decisions - e.g. PCP switching policies, new patient E&M codes being utilized for patients new to the plan but not new to the practice, handling member cost share in various corner cases
If you love running towards complex challenges and transforming them into solutions, if you want to make a potentially huge impact on many lives, and if you are looking for a disruptive startup with an inspiring and talented team, Devoted Health may be the place for you! 

Devoted is an equal opportunity employer.  We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.