Description
If you receive an offer of employment for this position, it is contingent on the satisfactory completion of a pre-employment background check, immunization review, and drug screen (including THC/Marijuana). CareOregon is a federal contractor and must comply with all federal laws.
Job Title
Associate Medical Director - Maternal, Child, and Youth
Department
Medical Management Administration
Exemption Status
Exempt
Requisition #
24391
Direct Reports
N/A
Manager Title
Medical Director, CPCCO
Pay & Benefits
Estimated hiring range $117,000 - $143,000 /year, 5% bonus target, full benefits.
Posting Notes
This is a hybrid position with a flexible part-time schedule. Travel will be needed to the Portland office and occasionally to the coast and Medford.
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, Medicare, or Maternal, Child, and Youth Strategy lines of business in a Coordinated Care Organization (CCO) environment. This position also may lead population health specific work, depending on the needs of CareOregon.
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 CCO Medical Directors, Senior Medical Director and/or other Medical Directors, the Quality Health Outcomes team develops, implements, and manages 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 CCO Medical Director, 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 and participate in CCO Clinical Advisory Panel (CAP) as an informal leader or member, 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.
Experience and/or Education
Required
Board-certified medical doctor or doctor of osteopathy in one of the primary care specialties, including obstetrics/gynecology (Internal Medicine, Family Practice or Pediatrics preferred)
Licensed physician (MD or DO) in the State of Oregon
Leadership experience in a managed care organization or practice setting, including, or following strong clinical practice activity
Preferred
Administrative graduate degree, certificate of educational achievement in medical administration, or equivalent
Experience working with a managed care organization
Knowledge, Skills and Abilities Required
Knowledge
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
Understanding of managed care operations
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
Skills and Abilities
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
Experience applying innovative and creative approaches to improve health care delivery
Skilled in quality management techniques in a large, organized managed care setting
Commitment to improving access and qual
Compensation Information:
$117000.0 / Yearly - $117000.0 / Yearly
Starting At: 117000.0 Yearly
Up To: 143000.0 Yearly
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