Surgical Associate Medical Director or Medical Director - Seattle, WA, United States - Cambia Health Solutions

Description

Surgical Associate Medical Director or Medical Director (DOE)
Remote in ID, OR, WA, UT
*Experience in a surgical specialty and/or coding experience is required

• These roles will participate in utilization management, provide clinical leadership and support to clinical teams to ensure our members receive quality, cost effective care yielding optimal outcomes.

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.

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.

Analyzes and uses data to guide the development and implementation of health care interventions that improve value to the member and employer.

Advises Health Care Services Leaders on related key performance metrics and the effectiveness of various efforts, initiatives, policies and procedures.

Identifies and communicates new opportunities in utilization management, provider contracting or other areas that would enhance outcomes and the reputation of the organization.

Provides clinical expertise and coordinates between internal clinical programs and providers of care to improve the quality and cost of care delivered to health plan members.

Supports internal communication or training that ensures service is provided to members and providers by a well-trained staff.
Promotes provider understanding of utilization management and quality improvement policies, procedures and standards.

Has periodic consultation with practitioners in the field and ensures that the organization has qualified clinicians accountable for decisions affecting consumers.

May manage staff including hiring, performance management, development and retention.
May participate in health plan credentialing operations and clinical aspects of the credentialing program and provider services support.

Demonstrated competency working with hospitals, provider groups or integrated delivery systems to effectively manage patient care to improve outcomes.

Strong communication and facilitation skills with internal staff and external stakeholders, including the ability to resolve issues and seek optimal outcomes.

Proven ability to develop and maintain positive working relationships with community and provider partners.

Knowledge of the health insurance industry, state and federal regulations, provider reimbursement methods and evolving accountable care and payment models.

General business acumen including understanding of market dynamics, financial/budget management, data analysis and decision making.
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 complex projects and programs and drive results across internal teams and/or external partners.

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

Medical Director would have a MD or DO degree, at least 5 years clinical experience, plus at least 2 years medical utilization management and/or case management experience (prefer health insurance experience and additional MHA or MBA training), or an equivalent combination of education and experience.

Required Licenses, Certifications, Registration, Etc.

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).

Qualification by training and experience to render clinical opinions about medical conditions, procedures and treatments under review.
Work is performed primarily in an office location.
Periodic travel to a different office location, provider office, or other meeting location.
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; performance history; 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.

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

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)
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. 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.

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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