job

About the Position:

Reporting to the Chief Health Officer/Chief Medical Officer (CHO/CMO), the Senior Medical Director, Medicare, will, in collaboration with clinical leadership, be responsible for improvement in the design, development and implementation of the Medicare care model, with particular focus on the D-SNP Models of Care.

 

Key Responsibilities:

• Partners with the CHO/CMO, Health Plan Medical Directors, and Directors of other Clinical Services teams, including integrated Population Health and STARS Program, Quality, Pharmacy, Provider Performance Management – both CHC-focused and other facilitated providers, and Care Management, to design, develop, implement, and sustain programs.
• Provides Medicare-focused clinical guidance for CHPW’s utilization, pharmacy, and case management activities.
• Partners with the CHO/CMO, Health Plan Medical Directors, Clinical Services, and the Healthcare Economics, Finance, and Claims departments in (1) the development and production of value-based contracts that align incentives that are most impactful for improved Medicare performance and growth; and (2) develop provider engagement strategies to help gain CHC and physician buy-in to support best practices in Medicare managed care programs. Is jointly responsible with the Health Plan Medical Directors for maintaining Clinical Practice Guidelines and authorization and referral of clinical coverage criteria as per regulatory requirements.

 

Knowledge, Skills, and Abilities:

• Demonstrated high proficiency and expertise in clinical work and cost-effective health care.
• Knowledge of the various components of Medicare managed care (quality improvement, disease management, population management, utilization management, case management, and pharmacy management).
• Knowledge of Medicare populations and Medicare Advantage Programs.
• Knowledge of HEDIS, CAHPS, STARS, NCQA, JCAHO, and other standardized certifications and quality measures.
• Knowledge of regulatory agencies and requirements.
• Must possess excellent communications skills to interface with providers, staff, and management.
• Able to manage multiple priorities and deadlines expediently and decisively.
• Able to manage difficult peer situations arising from medical care review.
• Appreciation of cultural diversity and sensitivity towards target populations.
• Exempt – Employees are expected to report to work as scheduled, participate in all assigned meetings, and meet established performance and accountability standards.

 

Required Qualifications:

• MD or DO; licensure to practice medicine in Washington State must be current and unrestricted.
• Completion of a residency program in a primary care specialty with current Board Certification.
• 3+ years of clinical practice and 1+ year of leadership experience in a managed care system.
• Prior experience with Medicare populations and Medicare Advantage programs.
• Ability to pass a criminal background check.
• No sanctions or exclusions from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.

 

Bonus Qualifications:

Additional business-related degrees, training, or demonstrated continuing education to remain current in medical and management areas strongly preferred.
Experience with community or migrant health centers or low-income populations.
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.

 

Compensation and Benefits:

The position is FLSA Exempt and is not eligible for overtime. Based on market data, this position pay range is $274,640 (minimum) to $388,610 (midpoint) to $502,590 (maximum) and has a 15% annual incentive target based on company, department, and individual performance goals.

• CHPW offers the following benefits for full-time and part-time employees and their dependents:
• Medical, Prescription, Dental, and Vision
• Telehealth app
• Flexible Spending Accounts, Health Savings Accounts
• Basic Life AD&D, Short and Long-Term Disability
• Voluntary Life, Critical Care, and Long-Term Care Insurance
• 401(k) Retirement and generous employer match
• Employee Assistance Program and Mental Fitness app
• Financial Coaching, Identity Theft Protection
• Time off including PTO accrual starting at 17 days per year
• 40 hours Community Service volunteer time
• 10 standard holidays, 2 floating holidays
• Compassion time off, jury duty

Connect with the Recruiter:

Erica Eikelboom, Principal & Executive Search Consultant
Morgan Consulting Resources, Inc. – Healthcare Executive Search Since 1995
erica@morganconsulting.com
linkedin.com/in/ericaeikelboom

 

About the Organization:

In 1992, Washington’s community and migrant health centers (CHCs) created Community Health Plan of Washington (CHPW) to provide health insurance to people who were not being served by traditional insurance companies. The CHPW network includes 21 Community Health Centers operating more than 190 clinics; more than 3,100 primary care provides; nearly 15,000 medical specialists; nearly 8,000 behavioral health specialists; over 100 hospitals; and more than 130 affiliate providers at 393 locations. With 640 employees, CHPW serves 15,000 Medicare members and 300,000 Medicaid members in addition to the Exchange public plan. CHPW serves Medicare Advantage Plan members in 27 counties across Washington and serves Medicaid members in all counties in WA state.

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