CareOregon
Medical Director - Clinical Services
CareOregon, Seattle, Washington, us, 98127
Career Opportunities: Medical Director - Clinical Services (24536)Requisition ID
24536
- Posted
08/21/2024
-
CareOregon
-
Full Time - Permanent
-
Portland
-
Multi Location (2)
Job Title:
Medical Director - Clinical Services
Department:
Medical Management Administration
Exemption Status:
Exempt
Requisition #:
24536
Manager Title:
Sr Medical Director - Clinical Services
Pay & Benefits:
Estimated hiring range $283,150 - $346,000/year, 10% bonus target, full benefits.
Posting Notes:
This role will focus on achieving better quality of care for a special needs, dually eligible Medicare population by understanding and applying D-SNP Medicare regulatory requirements, and in partnership with our network providers, develop a clinical strategy to improve population health, coordinate care, and meet CMS STARS measures.
Job SummaryThis position is responsible for leading a multidisciplinary, matrixed team in supporting both internal staff, as well as external network and other partners, in implementing effective care management, quality, and other clinical practice improvement initiatives as assigned, in support of the Quadruple Aim. Direct support may be focused on Medicaid or Medicare lines of business in a Coordinated Care Organization (CCO) environment.
Work includes four key areas:
Best practices and network support with focus on integration (physical health, behavioral health, oral health, social health)
Data support and translation with focus on quality improvement
Population health framework including strong equity focused approach and resource stewardship for vulnerable populations (including value-based payments)
Regional relationships and collaboration in a CCO environment
This position may be assigned to lead medical management, clinical informatics, behavioral health, and/or population health initiatives for the organization including clinical quality in the provider network.
Essential Responsibilities
In partnership with the Senior Medical Director and/or other Medical Directors, develop, implement, and manage clinical programs to address member needs.
Implement, direct, and oversee utilization, case, disease, and/or quality management programs.
Develop and implement programs for supporting participating physicians in optimizing quality management and utilization management.
Represent the health plan in applicable activities including medical and other professional organizations; participate in activities that enhance CareOregon's image within the community.
Provide medical support for Care Management activities.
Provide oversight of benefit determinations and appeals for medical and pharmacy as assigned by Senior Medical Director or CMO.
May partner with CCO leadership team to develop, implement, direct, and oversee programs that provide clinical strategy and interventions to CCO clinical systems.
May plan, participate in, or lead CCO Clinical Advisory Panel (CAP), depending on CCO/regional needs.
Support and implement programs for network providers to share best clinical practice using of population/panel management and performance data on clinical quality and utilization.
Organizational Responsibilities
Perform work in alignment with the organization's mission, vision and values.
Support the organization's commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
Strive to meet annual business goals in support of the organization's strategic goals.
Adhere to the organization's policies, procedures and other relevant compliance needs.
Perform other duties as needed.
Knowledge, Skills and Abilities Required
Medical policy knowledge and skills as related to quality, case and disease management, credentialing activities and utilization management
Clinical knowledge of the management of diverse medical problems, including impact of social concerns
Understanding of health equity and ways social inequities impact health
Basic knowledge of applicable regulatory and contractual requirements for Medicaid, Medicare and commercial insurance
Familiarity with guideline development, outcomes management, population health improvement, disease management and cost effectiveness and cost analysis studies
Awareness of physician/provider payment issues, physician practice models and total quality and continuous quality improvement concepts
Excellent communication and collaboration skills for work with network providers and internal employees; ability to effectively express ideas and gain acceptance
Ability to implement new and improved approaches to improvement of care and service quality, and to Care Management activities performed by CareOregon
Ability to implement clinical and wellness programs to address the needs of high-risk members
Ability to create excitement and bring individuals and teams together into a cohesive unit
Ability to lead and/or work effectively as part of a cross-functional, matrixed team and foster an environment where change is embraced and supported
Ability to deal with issues and problems systemically
Ability to plan, set priorities, delegate effectively and utilize time efficiently
Ability to apply innovative and creative approaches to improve health care delivery
Skilled in quality management techniques to apply in a large, organized managed care setting
Commitment to improving access and quality of care to the underserved and uninsured
Appreciation of cultural diversity and the needs of serving a diverse patient population
High degree of diplomacy, credibility and persuasiveness to consistently cultivate effective working relationships
An organized, disciplined, hands-on and process-oriented leader
Results-oriented decision-maker with the ability to balance diverse priorities
Proactive and action oriented; ability to drive performance
Education and/or ExperienceRequired:
Board-certified medical doctor or doctor of osteopathy in Family Medicine, Internal Medicine, or Pediatrics
Licensed physician (MD or DO) in the State of Oregon
Minimum 3 years' physician experience
Minimum 3 years' leadership experience in a managed care organization or practice setting
Preferred:
Administrative graduate degree, certificate of educational achievement in medical administration, or equivalent
Working Conditions
Environment: This position's primary responsibilities typically take place in the following environment(s): Inside/office, Clinics/health facilities, Member homes.
Travel: This position may include occasional required or optional travel outside of the workplace, in which the employee's personal vehicle, local transit, or other means of transportation may be used.
Equipment: General office equipment
Hazards: n/a
#LI-Hybrid
Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment.
Veterans are strongly encouraged to apply.
We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.
Visa sponsorship is not available at this time.
#J-18808-Ljbffr
24536
- Posted
08/21/2024
-
CareOregon
-
Full Time - Permanent
-
Portland
-
Multi Location (2)
Job Title:
Medical Director - Clinical Services
Department:
Medical Management Administration
Exemption Status:
Exempt
Requisition #:
24536
Manager Title:
Sr Medical Director - Clinical Services
Pay & Benefits:
Estimated hiring range $283,150 - $346,000/year, 10% bonus target, full benefits.
Posting Notes:
This role will focus on achieving better quality of care for a special needs, dually eligible Medicare population by understanding and applying D-SNP Medicare regulatory requirements, and in partnership with our network providers, develop a clinical strategy to improve population health, coordinate care, and meet CMS STARS measures.
Job SummaryThis position is responsible for leading a multidisciplinary, matrixed team in supporting both internal staff, as well as external network and other partners, in implementing effective care management, quality, and other clinical practice improvement initiatives as assigned, in support of the Quadruple Aim. Direct support may be focused on Medicaid or Medicare lines of business in a Coordinated Care Organization (CCO) environment.
Work includes four key areas:
Best practices and network support with focus on integration (physical health, behavioral health, oral health, social health)
Data support and translation with focus on quality improvement
Population health framework including strong equity focused approach and resource stewardship for vulnerable populations (including value-based payments)
Regional relationships and collaboration in a CCO environment
This position may be assigned to lead medical management, clinical informatics, behavioral health, and/or population health initiatives for the organization including clinical quality in the provider network.
Essential Responsibilities
In partnership with the Senior Medical Director and/or other Medical Directors, develop, implement, and manage clinical programs to address member needs.
Implement, direct, and oversee utilization, case, disease, and/or quality management programs.
Develop and implement programs for supporting participating physicians in optimizing quality management and utilization management.
Represent the health plan in applicable activities including medical and other professional organizations; participate in activities that enhance CareOregon's image within the community.
Provide medical support for Care Management activities.
Provide oversight of benefit determinations and appeals for medical and pharmacy as assigned by Senior Medical Director or CMO.
May partner with CCO leadership team to develop, implement, direct, and oversee programs that provide clinical strategy and interventions to CCO clinical systems.
May plan, participate in, or lead CCO Clinical Advisory Panel (CAP), depending on CCO/regional needs.
Support and implement programs for network providers to share best clinical practice using of population/panel management and performance data on clinical quality and utilization.
Organizational Responsibilities
Perform work in alignment with the organization's mission, vision and values.
Support the organization's commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
Strive to meet annual business goals in support of the organization's strategic goals.
Adhere to the organization's policies, procedures and other relevant compliance needs.
Perform other duties as needed.
Knowledge, Skills and Abilities Required
Medical policy knowledge and skills as related to quality, case and disease management, credentialing activities and utilization management
Clinical knowledge of the management of diverse medical problems, including impact of social concerns
Understanding of health equity and ways social inequities impact health
Basic knowledge of applicable regulatory and contractual requirements for Medicaid, Medicare and commercial insurance
Familiarity with guideline development, outcomes management, population health improvement, disease management and cost effectiveness and cost analysis studies
Awareness of physician/provider payment issues, physician practice models and total quality and continuous quality improvement concepts
Excellent communication and collaboration skills for work with network providers and internal employees; ability to effectively express ideas and gain acceptance
Ability to implement new and improved approaches to improvement of care and service quality, and to Care Management activities performed by CareOregon
Ability to implement clinical and wellness programs to address the needs of high-risk members
Ability to create excitement and bring individuals and teams together into a cohesive unit
Ability to lead and/or work effectively as part of a cross-functional, matrixed team and foster an environment where change is embraced and supported
Ability to deal with issues and problems systemically
Ability to plan, set priorities, delegate effectively and utilize time efficiently
Ability to apply innovative and creative approaches to improve health care delivery
Skilled in quality management techniques to apply in a large, organized managed care setting
Commitment to improving access and quality of care to the underserved and uninsured
Appreciation of cultural diversity and the needs of serving a diverse patient population
High degree of diplomacy, credibility and persuasiveness to consistently cultivate effective working relationships
An organized, disciplined, hands-on and process-oriented leader
Results-oriented decision-maker with the ability to balance diverse priorities
Proactive and action oriented; ability to drive performance
Education and/or ExperienceRequired:
Board-certified medical doctor or doctor of osteopathy in Family Medicine, Internal Medicine, or Pediatrics
Licensed physician (MD or DO) in the State of Oregon
Minimum 3 years' physician experience
Minimum 3 years' leadership experience in a managed care organization or practice setting
Preferred:
Administrative graduate degree, certificate of educational achievement in medical administration, or equivalent
Working Conditions
Environment: This position's primary responsibilities typically take place in the following environment(s): Inside/office, Clinics/health facilities, Member homes.
Travel: This position may include occasional required or optional travel outside of the workplace, in which the employee's personal vehicle, local transit, or other means of transportation may be used.
Equipment: General office equipment
Hazards: n/a
#LI-Hybrid
Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment.
Veterans are strongly encouraged to apply.
We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.
Visa sponsorship is not available at this time.
#J-18808-Ljbffr