The Medical Director – Tuality Health Alliance (THA) is responsible for assisting in the development and implementation of a comprehensive strategy directed toward improving the quality and efficiency of care delivered by THA providers. Works closely with the THA COO/Director to develop and manage relationships with major payers, individuals, and provider networks as they relate to the Physician Hospital Community Organization (PHCO), THA. In conjunction with the THA management team, the medical director is responsible for oversight of the operations of the THA Medical Management Program, including Referrals/authorizations, Utilization Management, decisions related to clinical review (based on the State of Oregon Rules and Laws, the Oregon Prioritized List, and medical necessity); and Quality Improvement and Credentialing, and participates on all related committees. Responsible for working with the Plan Director and Leadership physicians to set meeting agendas, present content, and to develop programs to enhance quality and the clinical integration of the PHCO. Works with THA’s Pharmacy Benefits Manager (PBM) to update and uphold THA’s formulary on an ongoing basis. Required to communicate with individual THA physicians to provide feedback and manage patient care. Responsible for working with the Hospital Administrative team to achieve mutual goals and with Health Share of Oregon Coordinated Care Organization as well as state-level workgroups and committees.
The Medical Director has the option to function as a clinician and would maintain active or courtesy staff privileges at Tuality Community Hospital. The Physician may practice outpatient clinical medicine and work collaboratively with a healthcare team in a clinic setting to provide comprehensive medical care to all patients served by Tuality Healthcare. The location of this physician practice would be determined by Hospital need and the Chief Medical Officer and would allow for seeing patients no more than 0.10-0.25 FTE per week (which would include any clinic administrative duties).
a) License: Maintains Oregon licensure.
b) Fulfills requirements of hospital medical staff credentialing process.
c) Maintains active, courtesy, or honorary staff membership in good standing with the medical staff of the hospital with all privileges and responsibilities accorded such membership.
d) Three or more years of physician management experience, including chronic care or other clinical care improvement program development which demonstrates leadership skills with an emphasis on a collaborative style.
e) Demonstrates skill in caring for specialty-related patients.
f) Uses effective communication skills taking into consideration body language, filters, listening, paraphrasing, and questions with customers of diverse ethnic and cultural backgrounds, as well as work with patients, families and co-workers in “simple” and “difficult” situations.
g) Excellent interpersonal skills and ability to work successfully with a broad range of physicians in solo and group practices.
h) Ability to be credible with physicians and honest and forthright in interactions.
i) Preference to background in medical case management.
j) Proven ability to work and communicate successfully with all levels of management (Executive Team, Board of Directors) and with Physicians, Administrators, senior health care leaders, and with business leaders including the ability to make effective small and large group presentations.
k) Excellent verbal, written, analytical, planning, and organizational skills.
l) Demonstrated ability to effectively represent THA on outside committees and organizations.
m) Experience with data analytics, standard office equipment and programs, and Electronic Medical Records systems. Must have strong working knowledge of Medicare and Medicaid programs, including the OHP.
n) Bilingual skills a plus.
At Tuality Healthcare, an OHSU Partner, it's an honor and a privilege to serve those near us. That's why since our beginnings in 1918, and as we expand our strong network of services through our clinical affiliation with OHSU, we continue to be committed to providing the best health care possible and a valued community partner. Our affiliation with OHSU brings the advanced medical resources of Oregon’s only academic health center, which allows local providers to receive guidance from some of the country’s top specialists and pass that expertise on to Tuality patients where they can be cared for in their community.
Tuality’s many awards showcase our position as one of the Portland metro area’s premier healthcare providers, including 5th straight year in Top 10 Healthiest Employers in Oregon from The Portland Business Journal, Tuality’s 6th straight Gold Plus Award from the American Heart Association, and 2016 #1 Nationwide Best Hospital IT Department to work for according to Healthcare IT News.
Here at Tuality our employees care about making a difference. In fact, they care so much that in our most recent employee satisfaction survey we had an 80% participation rate! Tuality is truly unique because of the relationships we build and as individuals we are seen and heard. Come be part of our team, and let your voice be heard!