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 Summary

This 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. 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 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 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

  Physical Skills and Abilities Required

  Lifting/Carrying up to 10 Pounds

  Pushing/Pulling up to 10 Pounds

  Pinching/Retrieving Small Objects

  Crouching/Crawling

  Reaching

  Climbing Stairs

  Repetitive Finger/Wrist/Elbow/

  Shoulder/Neck Movement

  0 hours/day

  0 hours/day

  0 hours/day

  0 hours/day

  0 hours/day

  0 hours/day

  More than 6 hours/day

  Standing

  Walking

  Sitting

  Bending

  Seeing

  Reading

  Hearing

  Speaking Clearly

  0 hours/day

  0 hours/day

  0 hours/day

  0 hours/day

  More than 6 hours/day

  More than 6 hours/day

  More than 6 hours/day

  More than 6 hours/day

  Cognitive and Other Skills and Abilities

  Ability 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 Experience

  Required:

• 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) (check all that apply on a regular basis):

  ☒ Inside/office ☐ Clinics/health facilities ☐ Member homes

  ☐ Other_

• 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.