Job Title

Responsibilities Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience. Learn more at: Job Summary: Reporting to the Chief Medical Officer of Prominence Health, the Medical Director of Value-Based Care integrates primary care performance management and value-based care (VBC) transformation. The Medical Director will drive and hold accountability over the recruitment and performance of partnered primary care groups through expanded peer-to-peer education, improving RAF accuracy, elevating STAR ratings, optimizing workflows, and leading measurable financial turnaround in support of PHP's value-based care strategy. The Medical Director will lead and direct the activities related to the achievement of value-based performance metrics in partnership with primary care groups resulting in sustained and measurable performance transformation. This individual will play a key role in the direction and execution of the success of primary care performance across all Prominence Health markets. Specifically, this role will lead physician engagement in the Prominence Health risk adjustment strategy, generate workflows and processes to ensure accurate and appropriate RAF documentation and coding, improve quality metric performance as measured by health plan star ratings through education and partnership with key physician leaders, provide leadership across Utilization Management, Case Management, Disease Management, Quality, Pharmacy, as initiatives pertain to value-based primary care success, will conduct individual provider partnership sessions focused on value-based healthcare performance reviews and accountability coaching, will identify high-variance providers and implement targeted interventions, will oversee clinical appropriateness, medical necessity determinations, and peer review processes, will collaborate with Provider Relations to influence behavior change and improve VBC outcomes, will analyze medical cost/utilization trends and implement interventions to mitigate adverse trends, will support recruitment and onboarding of value-aligned primary care clinicians, and will represent PHP at community, regional, and national clinical meetings. This individual is qualified, as determined by the medical director or clinical director, to render a clinical opinion or determination about medical or behavioral health conditions, procedures, and treatments and are knowledgeable of the current, evidence-based clinical guidelines, and novel treatments for medical or behavioral health conditions, diseases, treatments, or procedures. The Medical Director will hold active, unrestricted, valid, and current licenses to practice medicine in Nevada, Texas, and/or Florida and are board-certified by a specialty board approved by the American Board of Medical Specialties or the Advisory Board of Osteopathic Specialists or a Doctor of Podiatric Medicine. They are qualified to lead strategies in support of appropriate and accurate risk adjustment documentation and coding, improve quality performance through leadership of quality gap education and best practices, and will develop and implement initiatives for provider effectiveness and efficiency in the administration and delivery of value-based healthcare. Benefit Highlights: * Loan Forgiveness Program * Challenging and rewarding work environment * Competitive Compensation & Generous Paid Time Off * Excellent Medical, Dental, Vision and Prescription Drug Plans * 401(K) with company match and discounted stock plan * SoFi Student Loan Refinancing Program * Career development opportunities within UHS and its 300+ Subsidiaries! · More information is available on our Benefits Guest Website: About Universal Health Services: One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World's Most Admired Companies by Fortune; and listed in Forbes ranking of America's Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. Qualifications Qualifications and Requirements: * Doctorate Degree in Medicine; in addition to a Master's in health care administration or related field (MBA, MMM, MPH or MHA) preferred. * Board-certified by a specialty board approved by the American Board of Medical Specialties or the Advisory Board of Osteopathic Specialists or a Doctor of Podiatric Medicine. * Possess a current, valid, active, and unrestricted license or certification in a health profession to practice medicine in a state or territory of the United States, unless expressly permitted by state or federal law or regulation, when conducting the review, and is recognized in the relevant jurisdictions. * Free of sanctions from MD Medicaid or Medicare. * If there is a restriction that is allowed by a relevant jurisdiction, according to the medical director or clinical director, it is of the type that does not affect the health professional's ability to fulfill the roles and responsibilities of a reviewer. * Possess a license or certification in a health profession that is: For either a Doctor of Medicine or Doctor of Osteopathic Medicine; or is the same license or certification as the ordering practitioner. * Previous Associate Medical Director/Medical Director experience preferred. * Minimum five years clinical practice and post-graduate experience in direct patient care. * Familiarity with the principles of value-based health care and managed care. * Familiarity with HEDIS and or CAHPS, STARS, HOS, NCQA, URAC. * Excellent computer skills. * Strong internal relationship building skills required. * Strong external relationship skills required with contracted providers. * Excellent presentation, oral and written communication skills required. * Able to travel to all Prominence Health markets and represent the organization. EEO Statement All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success. Avoid and Report Recruitment Scams At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.