Medical Director, Value Based Care

Upperline Health Inc; Bowling Green, Northern (KY, KY); Hybrid; USD 180,000 - 290,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401K

PTO

Parental leave

Job summary

Upperline Health Inc in Kentucky seeks a Medical Director, Value Based Care to lead and grow our value-based care program across the market. You will partner with Operations and Population Health to deliver outcomes, manage care for Upperline Plus patients, and supervise medical management with APPs and physicians.

The role requires MD/DO, board certification, KY license, and prior clinical leadership in VBC or population health. Travel to clinics in the region is expected.

Qualifications

• MD or DO with board certification in Internal, Family, Preventive Medicine or Geriatrics.
• Active Kentucky medical license; multi-state licensure preferred.
• Fellowship in geriatrics or related advanced degrees valued.
• ~5 years outpatient practice with clinical leadership in VBC or population health.
• Experience with managed care and payer-provider collaboration.
• Ability to translate goals into actionable plans; strong leadership.

Responsibilities

• Oversee care management and medical management for Upperline Plus patients.
• Supervise medical management of region providers and APPs as needed.
• Be accountable for value-based care outcomes and utilization management.
• Drive VBC initiatives with APPs and physicians to improve outcomes.
• Analyze population health data to identify gaps and solutions.
• Educate providers on VBC metrics and best practices.
• Ensure regional adherence to quality, documentation, and engagement metrics.
• Design and manage new VBC programs and service lines.
• Lead interdisciplinary meetings for complex patient management.
• Build partnerships with specialists, home health and hospitals.
• Support onboarding and clinical coaching for new providers.
• Maintain regional provider relationships and referrals.
• Develop clinical compliance guidelines and protocols.

Skills

Clinical leadership

Data analysis

Communication

Project management

Excel

Team collaboration

Strategic planning

Education

MD or DO

KY medical license

Fellowship in geriatrics

MBA/MPH/MA in health

Tools

Population health analytics

Job description

Founded in 2017 and headquartered in Nashville,Tennessee,Upperline Health delivers comprehensivecare through a growing national network, with teams spanning podiatry,endocrine, primary care, urgent care,wound, vascular and more.The organization’s mission is to integrate and transform specialty care for chronically ill, high-risk patients through frequent specialist engagement and coordinated, value-based programs.

With a patient-centered approach, Upperline delivers care across 21 states and has been recognized asone ofthe nation’s largest multi-specialty physician practices. The platform has demonstrated meaningful improvements in outcomes, such aslowering hospitalization rates, decreasing total cost of care,reducingamputations,and accelerating wound-healing times, supported in part by its optimized EHR and analytics infrastructure.

Our Upperline Plus program isthe value-based care pillar of Upperline, which allows for the integration of primary and specialty care. Patients are part of full risk arrangements with Medicare and MA plans, and the Upperline Plus interdisciplinary teamextends an extra layer of support forhigh-riskpatients. This care model - a full interdisciplinary team(physicians, APPs, RNs, pharmacists, social workers)workingacrossclinics,home, and telehealth - reduces avoidableutilizationand total cost of care.

The Upperline team enhances the healthcare experience by living our Upperline CARES values—fostering strong Connections, holding ourselves to the highest level of Accountability, demonstrating Resilience in navigating and tackling complex challenges, committing to Excellence in patient care, and focusing on a Service mentality that places patients at the heart of everything we do.

ABOUT THE MEDICAL DIRECTOR, VALUE BASED CARE

Upperline is seeking a Medical Director, Value Based Care (VBC) to join the clinical leadership team in developing, implementing, and growing our unique value-based care model in Kentucky.

The VBC Medical Director will serve as a clinical leader partnering with Operations and Population Health leaders to deliver successful value-based care results across the market.

What You’ll Do

• Oversee the care management and medical management of the Upperline Plus patients being seen by Upperline’s Nurse Practitioners in the in the market or region
• Responsible for supervising medical management of patients in the region including clinical quality review of providers and serving as the collaborating physician for APPs in the region (as necessary based on state law)
• Accountable for value-based care outcomes (e.g., ADK, total cost of care), medical management, care management, utilization management, and quality improvement tools and processes in the region
• Manage and drive value-based care initiatives with APPs and doctors ensuring positive impact on patient outcomes
• Analyze population health data and identify gaps and develop solutions to improve delivery of care, decrease hospitalizations and reduce medical costs
• Educate providers on value-based care metrics and best practices and foster a culture that prioritizes accountability around outcomes-based performance
• Ensure the region is meeting VBC operations metrics such as addressing Quality gaps, accurate documentation, patient engagement and retention
• Design, implement and manage new value-based care programs and service lines in collaboration with population health and operations teams
• Conduct interdisciplinary team meetings to discuss management of the most complex patients (including high cost and high-risk patients
• Establish and maintain relationships with VBC team, specialists, and PCPs in the region; educate on Upperline Plus program and advocate for collaborative partnerships benefiting patients
• Support onboarding and training of new providers and provide onsite and virtual clinical coaching and feedback with a focus on ensuring consistency and continuous improvement of managing patients more efficiently
• Build relationships in the region and identify best partners (e.g., other specialists, home health agencies, hospitals) for Upperline to send referrals when needed
• Develop clinical compliance guidelines and protocols

Experience and Qualifications

• Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.)
• Board certified in Internal Medicine, Family Medicine, Preventative Medicine, or Geriatrics
• Active license in Kentucky and willing to pursue multi-state licensure if needed
• Fellowship training in Geriatrics and/or other advanced degrees (e.g., M.B.A., M.P.H., M.H.A.) valued but not required
• ~ 5 years of outpatient practice experience
• Clinical leadership experience in a VBC or Population Health company
• Experience with managed care and familiarity with payer-provider collaboration
• Owned or been part of creating, improving, and/or implementing clinical processes, protocols, or evidence-based guidelines
• Experience or exposure to rolling out and/ or managing VBC programs (e.g. Transitional Care Management, Complex Care Management, ED Diversion, Advanced Care Planning, High Risk Patient Outreach)
• Talent for synthesizing information and solving complex problems; can independently translate high-level goals into actionable plans
• Proven leadership skills and servant leadership mentality with a passion for people and culture
• Ability to communicate, collaborate and work effectively with staff, providers, and organizational leaders
• Self-starter with a bias for action orientation; demonstrates a service excellence mindset
• Exceptional organizational and project management skills and the ability to prioritize and multi-task autonomously
• Comfortable working in Excel; able to analyze data and present findings
• Must be willing and able to routinely visit clinics and providers within the region; Residing in the market is strongly preferred

BENEFITS

Comprehensive benefit options include medical, dental and vision, 401K, PTO and parental leave.

COMPENSATION

Compensation is commensurate to compensation for similar positions in the region and based on prior training and experience.

Job Type: Full-time

Equal Opportunity Employer
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