CareOregon
Medical Director - Clinical Services
CareOregon, Portland, Oregon, United States, 97204
Job Title
Medical Director - Clinical Services
Department
Medical Management Administration
Exemption Status
Exempt
Requisition #
24536
Direct Reports
N/A
Manager Title
Sr Medical Director - Clinical Services
Pay & Benefits
Estimated hiring range $283,150 - $346,000/year, 10% bonus target, full benefits.www.careoregon.org/about-us/careers/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 improvementPopulation 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 ResponsibilitiesIn 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. Serve as a representative and medical spokesperson for the plan in support of CCOs, Medicare, contract negotiations and/or other provider expansion activities.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 ResponsibilitiesPerform 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 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 RequiredMedical policy knowledge and skills as related to quality, case and disease management, credentialing activities and utilization managementClinical knowledge of the management of diverse medical problems, including impact of social concernsUnderstanding of health equity and ways social inequities impact healthBasic knowledge of applicable regulatory and contractual requirements for Medicaid, Medicare and commercial insuranceFamiliarity with guideline development, outcomes management, population health improvement, disease management and cost effectiveness and cost analysis studiesAwareness of physician/provider payment issues, physician practice models and total quality and continuous quality improvement conceptsExcellent communication and collaboration skills for work with network providers and internal employees; ability to effectively express ideas and gain acceptanceAbility to implement new and improved approaches to improvement of care and service quality, and to Care Management activities performed by CareOregonAbility to implement clinical and wellness programs to address the needs of high-risk membersAbility to create excitement and bring individuals and teams together into a cohesive unitAbility to lead and/or work effectively as part of a cross-functional, matrixed team and foster an environment where change is embraced and supportedAbility to deal with issues and problems systemicallyAbility to plan, set priorities, delegate effectively and utilize time efficientlyAbility to apply innovative and creative approaches to improve health care deliverySkilled in quality management techniques to apply in a large, organized managed care settingCommitment to improving access and quality of care to the underserved and uninsuredAppreciation of cultural diversity and the needs of serving a diverse patient populationHigh degree of diplomacy, credibility and persuasiveness to consistently cultivate effective working relationshipsAn organized, disciplined, hands-on and process-oriented leaderResults-oriented decision-maker with the ability to balance diverse prioritiesProactive and action oriented; ability to drive performance
Physical Skills and Abilities RequiredLifting/Carrying up to 10 PoundsPushing/Pulling up to 10 PoundsPinching/Retrieving Small ObjectsCrouching/CrawlingReachingClimbing StairsRepetitive Finger/Wrist/Elbow/Shoulder/Neck Movement
0 hours/day0 hours/day0 hours/day0 hours/day0 hours/day0 hours/dayMore than 6 hours/day
StandingWalkingSittingBendingSeeingReadingHearingSpeaking Clearly
0 hours/day0 hours/day0 hours/day0 hours/dayMore than 6 hours/dayMore than 6 hours/dayMore than 6 hours/dayMore than 6 hours/day
Cognitive and Other Skills and AbilitiesAbility to focus on and comprehend information, learn new skills and abilities, assess a situation and seek or determine appropriate resolution, accept managerial direction and feedback, and tolerate and manage stress.
Education and/or ExperienceRequired:Board-certified medical doctor or doctor of osteopathy in Family Medicine, Internal Medicine, or PediatricsLicensed physician (MD or DO) in the State of OregonMinimum 3 years’ physician experienceMinimum 3 years’ leadership experience in a managed care organization or practice settingPreferred:Administrative graduate degree, certificate of educational achievement in medical administration, or equivalent
Working ConditionsEnvironment: This position’s primary responsibilities typically take place in the following environment(s) (check all that apply on a regular basis):Inside/office Clinics/health facilities Member homesOther_________________________________________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 equipmentHazards: n/a#LI-HybridCandidates 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.
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Medical Director - Clinical Services
Department
Medical Management Administration
Exemption Status
Exempt
Requisition #
24536
Direct Reports
N/A
Manager Title
Sr Medical Director - Clinical Services
Pay & Benefits
Estimated hiring range $283,150 - $346,000/year, 10% bonus target, full benefits.www.careoregon.org/about-us/careers/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 improvementPopulation 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 ResponsibilitiesIn 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. Serve as a representative and medical spokesperson for the plan in support of CCOs, Medicare, contract negotiations and/or other provider expansion activities.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 ResponsibilitiesPerform 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 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 RequiredMedical policy knowledge and skills as related to quality, case and disease management, credentialing activities and utilization managementClinical knowledge of the management of diverse medical problems, including impact of social concernsUnderstanding of health equity and ways social inequities impact healthBasic knowledge of applicable regulatory and contractual requirements for Medicaid, Medicare and commercial insuranceFamiliarity with guideline development, outcomes management, population health improvement, disease management and cost effectiveness and cost analysis studiesAwareness of physician/provider payment issues, physician practice models and total quality and continuous quality improvement conceptsExcellent communication and collaboration skills for work with network providers and internal employees; ability to effectively express ideas and gain acceptanceAbility to implement new and improved approaches to improvement of care and service quality, and to Care Management activities performed by CareOregonAbility to implement clinical and wellness programs to address the needs of high-risk membersAbility to create excitement and bring individuals and teams together into a cohesive unitAbility to lead and/or work effectively as part of a cross-functional, matrixed team and foster an environment where change is embraced and supportedAbility to deal with issues and problems systemicallyAbility to plan, set priorities, delegate effectively and utilize time efficientlyAbility to apply innovative and creative approaches to improve health care deliverySkilled in quality management techniques to apply in a large, organized managed care settingCommitment to improving access and quality of care to the underserved and uninsuredAppreciation of cultural diversity and the needs of serving a diverse patient populationHigh degree of diplomacy, credibility and persuasiveness to consistently cultivate effective working relationshipsAn organized, disciplined, hands-on and process-oriented leaderResults-oriented decision-maker with the ability to balance diverse prioritiesProactive and action oriented; ability to drive performance
Physical Skills and Abilities RequiredLifting/Carrying up to 10 PoundsPushing/Pulling up to 10 PoundsPinching/Retrieving Small ObjectsCrouching/CrawlingReachingClimbing StairsRepetitive Finger/Wrist/Elbow/Shoulder/Neck Movement
0 hours/day0 hours/day0 hours/day0 hours/day0 hours/day0 hours/dayMore than 6 hours/day
StandingWalkingSittingBendingSeeingReadingHearingSpeaking Clearly
0 hours/day0 hours/day0 hours/day0 hours/dayMore than 6 hours/dayMore than 6 hours/dayMore than 6 hours/dayMore than 6 hours/day
Cognitive and Other Skills and AbilitiesAbility to focus on and comprehend information, learn new skills and abilities, assess a situation and seek or determine appropriate resolution, accept managerial direction and feedback, and tolerate and manage stress.
Education and/or ExperienceRequired:Board-certified medical doctor or doctor of osteopathy in Family Medicine, Internal Medicine, or PediatricsLicensed physician (MD or DO) in the State of OregonMinimum 3 years’ physician experienceMinimum 3 years’ leadership experience in a managed care organization or practice settingPreferred:Administrative graduate degree, certificate of educational achievement in medical administration, or equivalent
Working ConditionsEnvironment: This position’s primary responsibilities typically take place in the following environment(s) (check all that apply on a regular basis):Inside/office Clinics/health facilities Member homesOther_________________________________________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 equipmentHazards: n/a#LI-HybridCandidates 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.
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