Medical Director

JOB SUMMARY/PURPOSE

• 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.