Associate Medical Director or Medical Director - Oregon, United States - Cambia Health Solutions

Description

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Associate Medical Director or Medical Director

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locations

Renton, WA

Salt Lake City, UT

Medford, OR

Coeur d'Alene, ID

Lewiston, ID

time type

Full time

posted on

Posted 2 Days Ago

job requisition id

R-4856

Associate Medical Director or Medical Director (dependent on experience)
Remote must reside in ID, OR, WA, UT

In this role, physicians will participate in utilization management and provide clinical leadership and support to clinical teams to ensure our members receive quality, cost effective care yielding optimal outcomes.

General Functions and Outcomes May Include:
Provides clinical leadership for staff to ensure members receive safe, effective and cost efficient services.

Contributes to the development of various medical management strategies and tactics to drive results and achieve key performance metrics.

Conducts peer clinical review for medical necessity on utilization management authorization requests.

Provides clinical input on case management reviews working closely with the CM clinical staff.

Responsible for discussing review determinations with providers who request peer-to-peer conversations.

Participates on multiple teams to provide clinical input on medical policy reviews and development and may participate on committees that develop programs impacting clinical interventions, utilization management and case management.

An a lyz es a n d

us es

d ata to

guid e t h e

d e v e lopm e n t a n d

impl e m e n tat io n

o f

h ea l th

c a r e

in te rven t i o n s t h at

improv e

v a lu e to t h e

m e mb er a n d e mploy e r .

Advis es

H ea l th C ar e

S e rvic es

L ea d e r s on

r e l ated

k ey

perform a nc e

m et ric s a n d t h e e ff e c t iv e n e s s

o f

v a riou s e ffor t s ,

ini t i at iv e s ,

policie s a n d

proc e dur e s .

Id e n t ifi es a n d

communic ates

n ew

oppor t uniti es

i n

u t iliz at io n

m a n a g e m e n t,

provid er

con t r a c t in g

o r

o t h er a r eas t h at

woul d e nh a nc e

ou t com es a n d

th e

repu tat io n

o f t h e

org a niz at ion .

Provid es

clinic al e xp e r t is e a n d

coordin ates

b et w een

int e rn al

clinic al

progr a m s a n d

provid e r s

o f

c a r e

t o

improv e t h e

qu a li ty a n d

cos t

o f

c a r e

d e liv e r ed to health plan

m e mb e rs .

Ensur es et hic al

d e cisio n

m ak in g

i n

compli a nc e

wi th

con t r a c t u al a rr a ng e m e n t s ,

r e gul at ion s a n d

l e gisl at ion .

Suppor ts

in te rn al

communic at io n

o r t r a inin g t h at e nsur es

s e rvic e

i s

provid ed

t o

m e mb e r s a n d

provider s

b y a

w e ll- t r a in ed

s ta ff .

Promo tes

provid er

und e rs ta ndin g

o f

u t iliz at io n

m a n a g e m e n t a n d

qu a li ty

improv e m e n t

polici e s ,

pr o c e dur es a n d

st a nd a rds .

Provid es

guid a nc e a n d

oversigh t

fo r

clinic al

op e r at i o n al a n d

clinic al

d e cision-m ak in g a sp e ct s

o f t h e

pr o gr a m .

May participate in health plan credentialing operations and clinical aspects of the credentialing program and provider services support.

Minimum Requirements
D e mons t r ated

comp ete nc y

workin g

wi th

hospi ta ls ,

provid er

groups

o r

in te gr ated

d e liv e r y

sys te m s to

effectively manage patient care to improv e

ou t com e s .

S t ron g

communic a tion

a n d

f a cili tat io n

skill s

wi th internal staff and external stakeholders,

includin g t h e a bili ty to

r e solv e

issu es a n d

seek optimal outcomes.

Prov en a bilit y to

d e velo p a n d

m a in ta i n

posi t iv e

workin g

r e l at ionship s

wi th

communi ty a n d

provid er

p a r t n e rs .

K nowl e dg e

o f t h e

h ea l th

insur a nc e

indus t ry ,

s tate a n d

f e d e r al

r e gul at ions ,

provid er

r e imburs e m e n t

m et hod s a n d e volvin g a ccoun ta bl e

c a r e a n d

p ay m e n t

mod e ls .

G e n e r al

busin e s s a cum en

includin g

und e rs ta ndin g

o f

m a rk et

dyn a mics ,

fin a nci a l/budg et

m a n a g e m e n t,

d ata a n a lysi s a n d

d e cisio n

m ak ing .

Strong orientation to the application of data in managing health and quality.

Proven ability to develop creative strategies to accomplish goals and objectives, plan and execute

compl ex

proj e c ts a n d

progr a m s a n d

driv e

r e sul ts a cros s

in te rn al tea m s a nd/o r e x te rn al

p a r t n e rs .

D e mons t r ated a bili ty to e ff e c t iv e l y

l ead a n d

engage in a constructive manner with

o t h e rs .

Normally to be proficient in the competencies listed above

Associate Medical Director would have a MD or DO degree, at least 3 years clinical experience, or equivalent combination of education and experience.

M e dic al

Dir e c t o r

woul d

h ave a


M D
o r


D O
d e gr e e , at

l ea s t 5

y ea r s

clinic al e xperi e nc e,

plu s at least 2 years

medical utilization management and/or case management experience (prefer health insurance experience and additional MHA or MBA training) ,

o r an e quiv a l e n t

combin at io n

o f e duc at io n a n d e xp e ri e nc e.
Required Licenses, Certifications, Registration, Etc.
Licensed Physician with an MD or DO degree.

Active, unrestricted license to practice medicine in one or more states or territories of the United States, with one of these licenses in our four-state area (OR, WA, ID, UT).

Applicant must also live in four state area.

Board Certification required. Qualification by training and experience to render clinical opinions about medical conditions, procedures and treatments under review.
Work Environment
Work is performed primarily remote setting.

Periodic travel to a different office location, provider office, or other meeting location.

M ay

b e

r e quir ed to

wor k

ou t sid e

norm al

workin g

hour s.

Must be located in a state or territory of the United States when conducting a peer clinical review.

#LI-Remote
The expected hiring range for an Associate Medical Director

is

$208,500 - $282,500 and for a Medical Director is $229,000 - $310,000

depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location.
The bonus target for an Associate Medical Director is 25

% and for a Medical Director is 30%.
The current full salary range for this role is

$196,000 - $319,500 for an Associate Medical Director, and is $215,500 - $350,500 for a Medical Director.

Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits.

In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current.

Some highlights:
medical, dental, and vision coverage for employees and their eligible family members

annual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)

paid time off

varying by role and tenure in addition to 10

company holidays

up

to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance

(no vesting period)

up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)

one-time furniture and equipment allowance for employees working from home

up to $225 in Amazon gift cards for participating in various well-being activities. for a complete list see our External Total Rewards

page.

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace.

All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law.

A background check is required.
If you need accommodation for any part of the application process because of a medical condition or disability, please email

.

Information about how Cambia Health Solutions collects, uses, and discloses information is available in our

Privacy Policy

. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers

site.

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