Market Physician Executive - Georgia

Monogram Health•Macon, GA

1d•Remote

About The Position

Market Physician Executives (MPE) are mission-driven physician leaders dedicated to improving the well-being, quality of life, and health outcomes for patients. The MPE will lead Monogram Health’s in-home multi-specialty polychronic care model in an assigned market, which comprises 5-10 territories led by local advanced practice providers (APP), registered nurses (RN), licensed clinical social workers (LCSW), and pharmacists. The MPE will collaborate with Monogram Health’s Multi-Specialty Platform to leverage employed specialists for in-home specialty care. Monogram Health utilizes a proven risk-based model with proprietary next-generation AI algorithms to predict the appropriate level of care, ensuring health equity and equality. The MPE will focus on enhancing patient experience, population health outcomes, provider satisfaction, and reducing costs. The primary goal is to achieve exceptional outcomes through disease detection, evidence-based clinical pathways, and treatment. Reporting to the Regional Vice President, the MPE is a key clinical leader responsible for the development and oversight of clinical strategies, policies, programs, processes, protocols, guidelines, and operations that improve patient health outcomes within the market. The MPE oversees daily clinical and business operations, including direct patient care, care management services, social worker support, and pharmacy services. The MPE is expected to review and approve care plans and direct treatment plans for patients, collaborating with community physicians, facilities, and partners in peer-to-peer and direct patient care decision-making.

Requirements

Current state medical license without restrictions to practice and free of sanctions from Medicaid or Medicare.
Willingness to become licensed in multiple states.
MD (Medical Doctor) or DO degree from an accredited medical school.
BC or BE in an ACGME approved specialty such as Nephrology, Internal Medicine, Family Practice, Emergency Medicine, Critical Care, Cardiology, Endocrinology, Hepatology, or Geriatrics.
Active, unrestricted state medical license required in each state within the market, and ability to obtain additional states as needed.
Demonstrated experience applying evidence-based clinical criteria.
Experience in multispecialty, geriatrics and/or value-based care.
Advanced management and communication skills.
Experience with high need Medicare Advantage and managed Medicaid populations.
Experience with NCQA, HEDIS, Medicaid, Medicare, quality improvement, medical utilization management, and risk adjustment.

Responsibilities

Know, understand, and deliver on Monogram Health’s proprietary evidence-based clinical pathways.
Ensure adherence to established clinical guidelines and Monogram Model of Care.
Review and approve APP, RN, SW and Pharmacy plans of care.
Appropriate and timely patient document within Salesforce and Athena clinical activities, interventions, and tasks.
Review, approve and co-sign APP encounters.
Overall accountability for reducing total cost of care and Medical Loss Ratio.
Responsible for clinical outcomes to include, but not limited to, clinical interventions closure, inpatient/outpatient utilization, pharmacological prescribing and therapy management, multi-specialty platform and HEDIS/Gap Closure.
Actively lead daily high risk and concurrent review rounds.
Direct supervision of front line clinical and operations team members, which includes regular shadowing/ride-alongs in the field.
Oversee and delegate operational responsibility to Market Manager, to deliver on daily operations, such as patient engagement, scheduling, administrative oversight, strategic implementations, and P&L management.
Collaborate with Market Leadership to develop and maintain a market culture of clinical excellence, adaptability to change and patient outcome ownership.
Regularly assess and present market performance and outcomes to Executive and Senior Leaders.
Provide direct and indirect patient care (including diagnosis and treatment of acute and chronic diseases).
Engage with patients on treatment plans, community provider collaboration, and direct evidence-based care pathways.
Conduct Peer to Peer consults with community, facility, and health plan partners.
Order labs, referrals, and complete actions to drive patient outcomes, close care gaps, and Clinical Intervention closure.
Provide clinical guidance and direction to Market teams to drive Population Health Management activities, including identifying and intervening on High-Risk Patients, formulating strategies to reduce admissions/readmissions, complete quality post hospital discharge visits, and improving the quality of visits.
Collaborate with Medical Economics, Finance and other stakeholders to root cause and action against utilization trends impacting care and outcomes.
Present and guide population health strategies in clinical and operational meetings.
Conduct patient reviews to target high utilizers, high risk and high opportunity patients and patient cohorts.
Participate in Monogram On-Call rotation which will vary; e.g. 7 days on call minimum once/quarter.
Provide coverage for other MPEs, during PTO or vacancy, as needed.