Outpatient Services Director directs and implements the administrative processes and resources of an outpatient medical or specialty services facility or clinic. Ensures quality care and services for patients by implementing systems and operational procedures to coordinate service delivery. Being an Outpatient Services Director aligns processes with business, clinical, customer service, quality, and financial goals. Monitors, evaluates, and modifies programs while adhering to company guidelines and standards. Additionally, Outpatient Services Director requires a bachelor's degree. Typically reports to a director. The Outpatient Services Director typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. To be an Outpatient Services Director typically requires 3+ years of managerial experience. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. (Copyright 2024 Salary.com)
As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.
Essential Duties and Responsibilities include the following:
1. Understand, promote and manage with the principles of medical management to facilitate the right care at the right time in the right setting. 2. As part of a team of medical directors, nurses and coordinators, participates in the pre-service medical necessity review of patient care. 3. Reviews prior authorization requests for medical necessity with respect to Health Plans, CMS, third-party guidelines (i.e., McKesson InterQual, American Imaging Management, USPSTF) and medical group Medical Policies and Clinical Guidelines. 4. Does internet searches for other existing policies/guidelines/medical necessity indications for requested services in order to facilitate quality, cost-effective care. 5. Uses individual service requests, and larger scale analytics to identify outlier trends in utilization patterns; the successful candidate will be fluent in these diagnostics and be able to effectively engage and align the provider network to improve overall performance and patient-centered outcomes. 6. Identify high-risk patients and help coordinate care with the high-risk team. 7. In collaboration with the Medical Director may identify needs for and participates in the development and implementation of Care Management/Utilization Management policies and procedures to promote cost-effectiveness quality medical care. 8. Participates in peer-to-peer discussions with providers to discuss service request decisions as well as elective care plans for member. 9. Liaises with the appeals and grievances department and Health Plan Medical Directors when adverse determinations come under discussion. |
Education and/or Experience:
1. Doctor of Medicine degree. 2. Specialty training and/or managed care experience preferred. 3. Minimum of five years of prior clinical experience required, with at least two years of managed-care or health-plan experience preferred. 4. Must demonstrate a strong clinical fund of knowledge. 5. Must have familiarity with the principles of clinical research and have the ability to interpret and apply clinical guidelines and policies. 6. Strong proficiency in MS Office programs (i.e., Word, Excel, Outlook, Access and Power Point) and ability to conduct research over the internet. 7. Must have excellent communications skills both verbally and written. 8. Typing 50 words per minutes with accuracy. 9. Ability to deal with responsibility with confidential matters. 10. Must have strong organization skills. 11. Ability to work in a multi-task, high stress environment. 12. Must be able to handle multiple projects at one time, reset priorities day-to-day to meet deadlines, and know when to ask for assistance and direction when working with conflicting priorities. 13. Must be self-motivated, self-guiding, driven, and have high personal ethics. 14. Must have the ability to work with all levels of management and have the ability to develop positive working relationships with medical directors and company department heads. |
We offer a full benefits package which includes employer paid medical, pharmacy and dental benefits. We offer a generous PTO package, 401k Retirement Savings, Life Insurance, Flexible Spending Account (FSA), Tuition Reimbursement & Licensed Renewal Fees for our clinical staff.
Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.
Clear All
0 Outpatient Services Director jobs found in Costa Mesa, CA area