Physician Medical Director for MercyCare Health Plan in Janesville, WI

The critical thought leader we select for this important role will be accountable for identifying and promoting key strategies for continuously improving the outstanding quality and efficiency of care expected by our members. In addition to controlling costs through utilization management, case management, disease management and other strategies, this professional will direct, implement, and support quality and utilization-management strategies and business plans for the MercyCare Insurance Company markets.

Responsibilities include:

• Overseeing all initiatives and ongoing work in clinical programs, NCQA, HEDIS, credentialing, compliance with federal and state regulations, and management of grievance and appeal processes.
• Constantly evaluating and benchmarking of the resource-management system including utilization and case management.
• Monitoring/reviewing treatment recommendations by participating and non-participating providers for quality, appropriateness, and cost-effectiveness.
• Monitoring the constantly changing provision of care environment for changes in technique, technology, and protocols, and providing recommendations regarding plan member services.
• Reviewing quality-of-care issues and referring them to appropriate parties.
• Providing leadership and communication to physician groups and Mercyhealth leadership on care quality and efficiency issues.
• Staffing/chairing the Medical Management Committee and its subcommittees.
• Acting as NCQA project leader and providing management support for managed-care accreditation programs.
• Working with managed healthcare staff to develop/maintain measurement indicators.
• Submitting/presenting reports on utilization and quality activities to the health plan board of directors.
• Monitoring and ensuring the efficiency of the UM/QM staff.
• Directly supervising Medical Management and Quality Management, including the medical data analyst and the clinical pharmacist.

Required Credentials

• Status as a medical doctor with appropriate state licensure.
• Current board certification in primary care or emergency medicine.
• Five or more years of experience in direct patient care.
• Five or more years of experience in managed care or similar administrative role.
• Demonstrated leadership and relationship-building skills.

Other:

• Relocation assistance available.

Mercyhealth is a regional health system with over 700 employed physician partners, seven hospitals and 85 primary and specialty care locations throughout 50 northern Illinois and southern Wisconsin communities. We are committed to being a top integrated health care provider and continuously work to make life better for the people, families and communities we serve.

As an integrated health care provider, we provide exceptional, coordinated health care that spans four core service divisions: hospital-based services, clinic-based services, post-acute care and retail services, and a wholly owned insurance company. These four core service divisions make up our comprehensive, vertically integrated delivery system, and integrated delivery is what makes Mercyhealth unique in serving the full range of health care needs for our patients.

Mercyhealth offers over 85 specialty and subspecialty services, including orthopedic surgery, prehospital emergency services and training, neurosurgery, heart and vascular services, cancer care, plastic and reconstructive surgery and much more. When time is of the essence, our trauma centers are equipped with the latest technology and highly trained staff to provide immediate, life-saving care. We are a leader in obstetric, neonatal and pediatric services, offering the highest level of care available at our neonatal intensive care unit, caring for the most fragile preemies in the region’s only Small Baby Unit, and serving as a State of Illinois-designated Perinatal Center for an 11-county region.

Janesville is a city of about 66,000 people with 150,000 people in Rock County. Janesville has all the advantages and amenities of a smaller city while still having easy access to four larger cities (Madison, Milwaukee, Rockford, Chicago). The cost of living in Rock County is low and housing is affordable. The school system is very good with both public and private schools available. The Janesville park system is extensive and includes children’s play areas, pools, gardens, golf and many other activities. Janesville has many restaurants and there is excellent dining within 40 minutes in Madison and Lake Geneva.