Responsible for the development, maintenance, oversight and implementation of medical management policies, procedures and guidelines applicable to the facilitation of the provision of quality, cost effective care for the enrolled patient population of Samaritan Health Plans and IHN-CCO, including a focus on delegated Medical Management vendors.
Working with the Chief Medical Officer, oversees clinical and behavioral health care for products and services and oversees the health care needs of the membership.
Is accountable for, and provides professional leadership and direction to the utilization / cost management and clinical quality management functions.
Works collaboratively with other plan functions that interface with Medical Management. Assists in short and long range program planning, quality improvement and external relationships.
Works within Medical Management and with other departments for support, assistance and direction in overall medical management effectiveness.
Our ideal candidate will have the following :
- Experience with health plans, Oregon Medicaid’s prioritized list, and the Medicare population
- Experience or familiarity with the Medicare approval process for utilization management for Medicare / Medicaid programs
- Willingness to learn and openness to coaching
- Oregon MD or DO license upon hire is required
- We are open to remote out of state work in any of our approved states : Alabama, Alaska, Arizona, Arkansas, Connecticut, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, or Wisconsin
EXPERIENCE / EDUCATION / QUALIFICATIONS
Current unencumbered Oregon MD or DO licensure required.
Successful completion of a residency program in a primary care specialty with Board Certification required.
Three (3) years of clinical practice experience required.
One (1) year of leadership experience in a managed care system required.
Experience with community or migrant health centers preferred.
Experience in the development and implementation of effective health care policy, particularly in the areas of quality monitoring, medical appropriateness, and utilization of health care services preferred.
Additional business related degrees or training strongly preferred.
KNOWLEDGE / SKILLS / ABILITIES
Effective written and verbal communication skills to perform group presentations, tactfully discuss issues, and listen to and understand concepts, rules and procedures.
Ability to work with all levels within the organization, facilitate communication, and effectively document related activities.
Ability to identify complex problems, review related information, employ creativity and alternative thinking to develop and evaluate options and implement solutions.
PHYSICAL DEMANDS
Rarely
1 - 10% of the time)
Occasionally
11 - 33% of the time)
Frequently
34 - 66% of the time)
Continually
67 100% of the time)
CLIMB - STAIRS
LIFT (Floor to Waist : 0"-36") 0 - 20 Lbs
LIFT (Knee to chest : 24"-54") 0 20 Lbs
LIFT (Waist to Eye : up to 54") 0 - 20 Lbs
J-18808-Ljbffr
Medical Director
Responsible for the development, maintenance, oversight and implementation of medical management policies, procedures and guidelines applicable to the facilitation of the provision of quality, cost effective care for the enrolled patient population of Samaritan Health Plans and IHN-CCO, including a ...
Medical Director - West
In the Medical Director role you will provide oversight for medical policy implementation. You'll participate in the development, implementation, and evaluation of clinical/medical programs and expand Aetna's medical management programs to address member needs across the continuum of care You will s...
Director - Engineering
We are seeking a Director - Engineering/Construction to join our Engineering department. Low-cost Medical / Dental / Vision Insurance. ...
Medical Director - Spine
Aetna, a CVS Health Company, has an exciting opportunity for a Medical Director (Spine) that can be remote based, work from home. The Medical Director (Spine) will be a Subject Matter Expert (SME) with a background in Orthopedic Spine OR Neurosurgery, including post-graduate direct patient care expe...
Integrative Medicine Medical Director
FTE admin time as a Medical Director, and 0. Group includes 6 physicians, 2 licensed acupuncturists, and LCSW, and a dietitian* Engage in medical education through the teaching of residents and medical students who rotate through the clinic. Other training in functional medicine, lifestyle medicine,...
Medical Director - Medicare Appeals
Responsibilities of this Medical Director role are related to Medicare Appeals. An Active state medical license without encumbrances. Medical Management - Medicare Complaints, Grievance & Appeals experience. The Company offers a full range of medical, dental, and vision benefits. ...
Medical Director at Willamette Veterinary Hospital in Corvallis, OR
The Medical Director (MD) of Mission Veterinary Partners (“MVP”) will own responsibility for ensuring Clinic Revenue Targets are achieved and minimum Standards of Care are developed and complied with at the hospital level. This Medical Director also provides strategic direction, coaching, and mentor...
Director-Samaritan Medical Group Nursing Services
Directs the management of ambulatory nursing operations and the clinical practice of the ambulatory primary, specialty, and urgent care clinics in partnership with AVP- Operations and Senior Medical Directors. ...
Medical Director, Utilization Management
Two (2) years of previous medical director experience working for a health plan, medical group, or hospital in utilization management or medical management. As a Medical Director in Utilization Management, you share responsibility for leadership in the appropriate use of medical services within esta...
Associate Medical Director BH or UM Medical Director
Associate Medical Director Behavioral Health or UM Medical Director. As a member of the Utilization Management team, our Associate Medical Director Behavioral Health and UM Medical Directors provides leadership, and clinical oversight for behavioral health operations across all lines of business wit...