Medical Director – CCO
Are you excited to step into a complex world that requires a blend of mind, heart and flexibility? We at CareOregon have been strengthening communities since 1994 by making health care work for everyone. As a nonprofit health plan largely focused on Oregon’s Medicaid population, we find fulfillment in supporting the underserved.
And we’re committed to that work in various areas of our wondrous state—including Jackson County, in Southern Oregon. The region is anchored by the small city of Medford, home to our office and in easy reach of rushing rivers, the Pacific coast, Shakespearean plays, wine country, and the majesty of the Rogue River-Siskiyou National Forest. Please consider joining us here at Jackson Care Connect, our Coordinated Care Organization dedicated to our members’ physical, emotional and oral health. We look forward to your application!
General Statement of Duties
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.
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/Coordinated Care Organization (CCO) network. The position may provide ground level clinical direction in support of CareOregon CCO transformation and process improvement efforts.
Essential Position Functions
With the Senior Medical Director and/or CMO, develop, implement, and manage clinical programs to address the needs members.
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, contract negotiations and 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 and participate in CCO Clinical Advisory Panel (CAP) as formal leader of group (if designated CAP chair) or informal leader as member.
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.
Essential Department and Organizational Functions
Propose and implement process improvements.
Meet deadlines for completion of workload.
Maintain agreed upon work schedule.
Demonstrate cooperation and teamwork.
Provide cross-training on specific job responsibilities.
Meet identified business goals that contribute to departmental goals.
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
Basic knowledge of applicable regulatory and contractual requirements for Medicaid, Medicare and commercial insurance
Understanding of managed care operations
Excellent communication and collaboration skills for work with network providers and internal employees
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 quality of care to the underserved and uninsured
Appreciation of cultural diversity and the needs of serving a diverse patient population
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
High degree of diplomacy, credibility and persuasiveness to consistently cultivate effective working relationships; ability to effectively express ideas and gain acceptance
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
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
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
Administrative graduate degree, certificate of educational achievement in medical administration, or equivalent
Experience working with a managed care organization
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
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
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.
Equal opportunity employer. This company considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.Position Description »