Medical Director

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.

General Statement of Duties

The Medical Director is responsible for implementing effective care management and other clinical practice improvement initiatives as assigned. 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/ CCO network, as well as utilization, quality, case management and disease management operations, monitoring and results. The position may provide ground level clinical direction in support of CareOregon CCO transformation and process improvement efforts. A Medical Director may have the direct responsibility for benefit management, as assigned by the Senior Medical Director and may have supervisory responsibilities of certain staff as assigned. May have a matrixed reporting relationship to CCO Executives.

Essential Position Functions

With the Senior Medical Director, develop, implement and manage clinical and wellness programs to address the needs members
Implement, direct and oversee utilization, case, disease, and/or quality management programs
Develop and implement programs for educating participating physicians regarding quality management and utilization management issues
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 the leadership necessary to maintain a motivated, productive and competent team through open communication and delegation of responsibilities and authority. Guide and direct subordinates in their personal and professional development
Provide medical support for Care Management activities
Provide medical director oversight, benefit determinations and appeals for medical and pharmacy as assigned by Senior Medical Director
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 educating network providers regarding best clinical practice using of population / panel management and performance data on clinical quality and utilization
May have supervisory duties

Essential Department and Organizational Functions

Provide coaching and training on specific job responsibilities as assigned
Perform other duties and projects as assigned

Management and Leadership

Train, supervise and evaluate performance of assigned staff
Provide staff with the training, mentoring and resources necessary to carry out their work
Ensure adherence to department and organizational standards, policies and procedures
Ensure performance goals, expectations and standards are clearly understood by supervised staff
Evaluate employees’ performance on an ongoing basis and take appropriate corrective action if needed
Perform human resource functions in collaboration with Human Resources

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
Excellent communication and collaboration skills for work with network providers and internal employees
Basic knowledge of applicable regulatory and contractual requirements for Medicaid, Medicare and commercial insurance
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
Understanding of managed care operations
Ability to create excitement and bring individuals and teams together and meld into a cohesive unit.
Ability to work effectively as part of a cross-functional team and foster an environment where change is embraced and supported
Ability to deal with issues and problems systemically
A track record of successfully managing, developing and motivating others to meet objectives
Proven ability to work as an integral part of a team
Ability to plan, set priorities, delegate effectively and utilize time efficiently
Experience applying innovative and creative approaches to improve health care delivery
Demonstrated use of quality management techniques in a large, organized managed care setting
Demonstrated 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
Demonstrated ability to attract, develop and build outstanding, committed and style-diverse clinical teams through collaboration
A high degree of diplomacy, credibility and persuasiveness to consistently cultivate effective working relationships. Effectively expresses ideas and gains their acceptance
An organized, disciplined, hands-on and process-oriented leader
High-energy, persistent, assertive, data driven and focused
Proactive and action oriented. Drives performance
Good at facilitating group goals
Posses a high degree of initiative and motivation along with the ability to effectively support and collaborate with others to achieve business objectives.

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

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More than 6 hours/day

Standing

Walking

Sitting

Bending

Seeing

Reading

Hearing

Speaking Clearly

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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

Requires 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). An administrative graduate degree, certificate of educational achievement in medical administration, or equivalent is desirable. Must be a results-oriented decision-maker with the ability to balance diverse priorities. At least three years of progressively responsible managerial experience is highly desirable, preferably to include managed care, quality assurance, utilization review and case management experience. Requires several years of progressive leadership experience in a managed care organization or practice setting (Medicaid experience preferred), including or following strong clinical practice activity. A current unrestricted license to practice is required.

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
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 »