Wexford Health Sources, one of the nation's leading innovative correctional health care company, provides clients with experienced management and technologically advanced services, combined with programs that control costs while ensuring quality. For nearly two decades, Wexford Health has consistently delivered proven staffing expertise and a full range of medical, behavioral health, pharmacy, utilization management, provider contracting, claims processing, and quality management services.
At Wexford Health our philosophy is that health care should not be considered a luxury for anyone. We simply care for those in need and the corrections environment is our venue.
Wexford Health has an exceptional opportunity for a Statewide Utilization Management Medical Director to join our team of healthcare professionals for the state of Maryland in Baltimore, MD.
We’re proud to offer a competitive benefits package including:
- Annual review with performance increase
- Generous paid-time off program that combines vacation and sick leave
- Paid holidays
- Comprehensive health insurance through Blue Cross Blue Shield
- Dental and Vision insurance
- 401(k) retirement saving plans
- Company-paid short-term disability
- Healthcare and dependent care spending account
Serves as a liaison between the medical/clinical staff, correctional site operations, corporate and regional offices, and the state correctional and medical leadership for all things related to Utilization Management. Works closely and provides leadership for the Utilization Management Department. Oversees medical practices in order to ensure and promote high-quality medical care. Maintain a close working relationship with the Corporate Medical Director, Statewide Medical Director, Operations Director, and the Utilization Management Department. Responsible for maintaining utilization management and clinical practice standards through the application of the organization’s clinical criteria; participates in the development of medical/clinical policies and case consultation to clinical staff, and represent organization’s clinical philosophy to patients, providers, facility personnel, and the community.
- Works closely with and maintains good relationships with the Chief Medical Officer, the Vice President of Medical Services and the UM Department of Wexford Health Sources.
- Actively engaged in helping to identify and facilitate the solving of all clinical issues as related to UM for all sites in the organization.
- Serves as a resource to the Corporate Medical Director, Statewide Corporate Medical Directors and Director of Operations in planning and budget activities for their respective regions, including:
- Participating in the development of proposed priorities for services and programs.
- Soliciting medical staff input on new chronic care programs and specialty services that might improve utilization and cost effectiveness of care.
- Identifying and implementing cost reduction strategies.
- Ensure budgetary compliance.
- Participates in the recruitment of medical and clinical staff as requested by the Corporate Medical Director.
- Assumes a leadership role in the development of subordinate staff in matters related to Utilization Management:
- Participates in new employee orientation
- Maintains consistent communication with staff
- Coaches staff to improve cost effectiveness of care delivery
- Implements and administers Wexford, state, and county policies and procedures consistently.
- Demonstrates proficiency with Wexford Health Sources internal and external information technology platforms (e.g. WexCare, WexLink, electronic medical records, telemedicine, etc.)
- Actively participates in Wexford management meetings/committees.
- Keeps organizational audiences informed of issues in a timely manner, including the submission of requested reports.
- Serves on appropriate task forces, committees, and state, county, and community agencies/ boards representing the organization.
- Makes presentations to the professional community in order to enhance the visibility and image of the organization.
- Effectively communicates with the Chief Medical Officer, Chief Operating Officer, Vice President of Medical Services, Regional Vice President(s), Site Medical Directors, and Regional Manager(s).
- Accepts other duties as assigned by the Chief Medical Officer and/or the Chief Operating Officer.
- Participates in the evaluation and monitoring of chronic illness programs in each facility within the region.
- Ensures that the operation of on-site infirmaries in each region are in compliance with national standards (ACA and NCCHC) and that the scope of care provided is appropriate for the staffing and resources available.
- Assists in the review of corporate, regional, state, and site-specific medical practices ensuring consistency with Wexford Health Sources’ overriding objective to promote high-quality medical care.
- Actively participates in Wexford’s Corporate Quality Management Committee.
- Maintains a working knowledge of applicable federal, state and local laws, and standards of conduct, as well as other policies and procedures from national accreditation standards (e.g., ACA, NCCHC, etc.) in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.
- Participates and actively performs when requested by the Chief Medical Officer or Regional Medical Directors, peer review activities in accordance with Wexford policies and procedures.
- Actively performs mortality and sentinel event reviews for the region and for other regions when requested by the Chief Medical Officer in accordance with Wexford policies and procedures.
- Serves as an ex-officio member of all standing medical staff committees of which they are not otherwise a formal member.
- Actively leads region- and corporate-wide efforts to ensure compliance with as well as meeting and/or exceeding national
- Serves as a clinical liaison and resource to all wardens and state/county government officials. This includes the attendance at warden and state/county official lead meetings as requested.
- Oversees and helps to lead any and all efforts towards the implementation and maintenance of electronic medical records, telemedicine, or administrative technology enhancements.
- Actively leads all Utilization Management (UM) efforts across the organization, including the establishment and successful attainment of UM annual and monthly goals.
- Tracks and trends all utilization.
- Works closely with and forms a good professional relationships with the Regional Medical Directors and Site Medical Directors.
- Responsible for daily inpatient reviews for all hospitalized patients across the organization. Ensures that daily communication occurs with the attending physician (contracted or non-contracted) of all patients under Wexford’s care receiving inpatient medical care.
- Ensures that daily communication occurs with the concurrent Review Nurses regarding each inmate receiving inpatient care.
- Responsible for overseeing Emergency Room Retrospective Reviews at least monthly and interacting with the Regional and Site Medical Directors concerning trends as needed.
- In coordination with the Regional Medical Directors, performs regularly scheduled collegial Review for all elective offsite referrals with the Site Medical Directors via teleconferencing or videoconferencing in conjunction with the assigned Referral Nurses.
- Responsible for leading pharmacy collegial reviews, laboratory and radiology utilization review.
- Responsible for the evaluation of all off-site utilization in the region in order to ensure its cost effectiveness and clinical quality.
- Responsible for providing educational support, evidence-based medical guidelines, medical research findings and appropriate resources for the Regional & Site Medical Directors.
- Responsible for interacting with the Regional Medical Directors concerning trend and performance issues related to the Site Medical Directors’ handling of all offsite services.
- Responsible for maintaining appropriate collegial/professional relationships with the UM staff, including becoming proficient in the use of WexCare to enhance the electronic transfer of information for the purposes of utilization management.
- Act as a clinical claims consultant as needed.
- Responsible for helping to establish and foster appropriate collegial/professional relationships with specialists, hospitalists, ancillary providers, transport providers, community and tertiary hospitals, and all other support groups that may be called upon to provide health care services for the Wexford patient population.
- Responsible for helping to identify (in conjunction with the Wexford Contracting Department) appropriate, qualified specialists, hospitalists, ancillary providers, transport providers, and other support groups necessary to provide high-quality, cost-effective care to Wexford’s patient population.
- Reviews and responds to all Provider Utilization Management appeals.
- Recommends UM and Medical Policy & Procedure changes as appropriate.
- Personally ensures completion of proper orientation and training related to Utilization Management of all new Site Medical Directors.
- Identifies educational opportunities from quality improvement initiatives and utilization review for individual providers as well as region-wide opportunities and identifies methods to deliver clinical education to the medical and clinical staff.
- Promotes appropriate continuing medical educational opportunities relevant to corporate and regional quality improvement and UM goals and objectives.
- Identifies potential future Wexford leaders from the clinical and medical staff and discusses with the Chief Medical Officer, Chief Operating Officer, and/or Regional Vice Presidents the educational support and advancement opportunities available for those individuals on an ongoing basis.
- Identifies promising medical and clinical leaders from throughout the region and recommends their appointment to existing medical staff committees.
- Attends meetings of professional societies as a representative of Wexford Health Sources.
ADDITIONAL DUTIES AND RESPONSIBILITIES:
- Maintain the confidentiality of inmate records.
- Comply with correctional facility’s policies and procedures.
- Approach change in a positive manner.
- Promote cost control through effective supply inventory, staff education, security and efficient use of supplies and resources.
- Provide input into developing needed policies and procedures.
- Actively participate in committee assignments.
- Use effective problem-solving techniques.
- Apply appropriate decision making behavior.
- Perform other duties as assigned.
The duties and responsibilities outlined herein are for payroll purposes only; employees may be assigned other duties as required.
Standard office environment when at the Maryland Regional Office and when traveling – standard medical setting within a correctional facility, which includes daily interfacing with offenders/patients, correctional staff, and health care personnel.
TRAVEL: Minimal travel throughout region and state is required.
LICENSING: Must have a current Maryland state medical license.
- Current American Heart Association CPR certification.
- Board Certification in Internal Medicine or Family Practice preferred.
- CCHP Preferred
- Graduate of an accredited medical school. M. D. Degree is required.
- MBA, or a Master's Degree is preferred in healthcare, or other related fields of study.
PREFERRED EXPERIENCE: Ten (10) years of clinical practice in a primary care setting and progressively responsible medical administrative experience preferred.
OTHER PREFERRED KNOWLEDGE, SKILLS AND ABILITIES:
- Strong interpersonal skills
- Strong verbal and written communication skills.
- General math and analytical skills, and planning, administrative and organizational skills essential.
- Demonstrated experience maintaining multiple deadlines. Must ensure documents are ready for review well in advance of any deadline.
- Ability to competently manage multiple priorities simultaneously.
- Ability to work in a stressful environment
- Must be able assist staff with various policies, administrative and organizational projects. "team-player" as this position requires daily coordination with other coworkers.