Medical Director, Value-Based Care

Be a part of the team building the future of healthcare!

Firefly Health is building a revolutionary new type of comprehensive health "care and coverage,” powered by a relationship-driven care team, a trusted virtual and in-person clinical network, and our proprietary technology platform.

Founded by experienced clinicians and technology leaders, Firefly Health is on a mission to deliver clinical and financial health through joyful, always there care. We are flipping the script on what it means to be a health plan and actually providing a true health benefit to members.

We are intensely focused on optimizing the physical + mental + financial wellbeing of those who want (and deserve) something better than the status quo. If you are ready to roll up your sleeves and take on our audacious mission, then we would love to hear from you.

Description

As the Medical Director, Value-based Care you will play a pivotal role in overseeing our clinical care programs across all customer segments. Your leadership will be integral in driving strategic medical initiatives, ensuring the delivery of high-quality care, and optimizing outcomes aligned with the company's mission. You will lead a multidisciplinary clinical team, collaborate cross-functionally, and uphold regulatory compliance standards while fostering a culture of diversity, equity, and inclusion.

Key Responsibilities:

1. Value-Based Care Leadership:

• Collaborates with the Chief Clinical Officer to identify modifiable Total Cost of Care reduction areas of opportunity. 
• Provide medical leadership, guiding the development and implementation of evidence-based clinical programs, including protocols, procedures, and outcome measurements, to succeed in shared saving programs while providing the highest quality care. Areas will include, but not limited to, capturing accurate risk adjustment, population segmentation service design, care management/high risk patient programs, and care pathway implementation.
• Working with analytics team, leverage insights from claims data to drive reductions in low value and modifiable expense through clinical programs and pathways

• Ensure health equity outcomes are a part of key all initiatives, including measuring and addressing any outcome disparities. 
• Lead continuous quality improvement initiatives to increase efficiency and effectiveness of disease specific and BH clinical programs.
• Establishes quantitative and qualitative metrics, benchmarks, and guidelines by which the care model’s efficiency and effectiveness can be evaluated
• Provide medical oversight to the Quality Performance team to ensure that Firefly exceeds the performance standards and requirements of our clients including identifying opportunities for improvement and implementing gap closure processes.

2. Clinical Team Leadership:

• Lead and manage the clinical team managers, RN, NP, Behavioral health, health guide managers, including hiring, retention and development. 
• Lead primary care physicians including hiring, retention, development, clinical supervision and quality assurance
• Contribute to clinical policies to ensure members and patients receive safe, effective care at all times. 
• Collaborate cross-functionally with Operations, Network, Product, Marketing, Sales, and Technology teams to integrate clinical perspectives into the Firefly platform and products.

3. Quality Assurance, Regulatory, and Compliance:

• Oversee clinical supervision and quality assurance in partnership with the Assistant Medical Director.
• Working with General Counsel and Operations, ensure Firefly care teams are meeting regulatory compliance
• Chair the Patient Safety committee

4. Efficiency 

• Partner with Operations, Product leadership to conceptualize and operationalize clinical, product and operational strategies that scale the clinical team
• Test, change, deploy and maintain processes to meet efficiency and volume KPIs

5. Clinical Care

• 25% of this role’s FTE will be in direct synchronous and asynchronous virtual patient care in the Firefly Care Model in collaboration with an NP. Health Guide, RN, and Behavioral Health Specialist. 
• Conduct virtual consultations with patients to assess medical concerns, provide diagnoses, and develop personalized treatment plans.
• Oversee a limited amount of Nurse Practitioner (NP) collaborative practice agreements and serve as the physician supervisor 
• Take home call one week at a time on a predictable schedule to address patients’ urgent health needs, frequency is prorated to clinical FTE

Job Requirements:

• Experience with ACO, AQC, or other value-based contract performance.
• Demonstrated success in reducing TCOC in a care delivery organization.
• Proficiency in HEDIS accountable quality measures performance.
• Strong leadership and people management skills.
• Experience leading multidisciplinary clinical teams.
• Experience in a healthcare tech growth environment
• Active and unrestricted medical license in good standing.
• Board certification in internal medicine, family medicine, or emergency medicine.
• Minimum of 7+ years of direct clinical experience and 5+ years of leadership experience.

If you meet these requirements and are passionate about leading transformative clinical initiatives, we encourage you to apply. Join us in revolutionizing healthcare delivery and making a positive impact on patient outcomes.

Our office is in Watertown, Massachusetts, but we’ve developed a robust remote working structure to give us more geographical flexibility while hiring for many positions. This role can be done largely remotely, there are several times a year when staff come together onsite for planning and team building.  

Firefly is an equal opportunity employer. We value diverse backgrounds and perspectives. We're committed to building and sustaining an inclusive workplace culture where individuals are treated with dignity and respect. All employment is decided on the basis of qualifications, merit, and business need. Firefly is an E-Verify employer.