Jobs for People with MS: National MS Society

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Join PacificSource and help our members access quality, affordable care!

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person\'s talents and strengths.

The Medical Director for Medicaid is a vital member of the leadership team responsible for the oversight and management of the PacificSource Medicaid Line of Business (PacificSource Community Solutions) and the health services department.This position will work closely with the VP of Medicaid Programs, individuals responsible for government procurement, other executive management group leaders, CCO Directors and associate medical directors, and other internal and external stakeholders associated with PacificSource\'s Medicaid line of business.

Essential Responsibilities:

• Review and make clinical determinations on coverage for pre or post service requests in accordance with evidence based guidelines, the Oregon Health Authority (OHA) prioritized list of health services, CMS coverage guidelines, and internal PacificSource policies. These determinations include but may not be limited to physical health, behavioral health, and oral health.
• Collaborate with other health services directors, CCO directors and CCO associate medical directors to create and drive clinical and business strategies focused on improving clinical performance, member experience, trend management, and quality.
• Provide managerial oversight to CCO associate medical directors
• Participate actively in various external and internal committee meetings
• As requested, develop strategy and subsequently engage with regulatory entities to fulfill obligations and execute on contractual commitments associated with the Medicaid line of business.
• Lead clinical activities connected to PacificSource\'s growth for the Medicaid line of business, and participate as a key leader in procurement activities.
• Participate in other clinical or administrative oversight, planning or management as designated from time to time.
• Work with the Senior Medical Director and the Chief Medical Officer on various projects as assigned
• Coordinate business activities by maintaining collaborative partnerships with key departments.
• Actively participate in the organization as a team member and physician leader at all times.

Supporting Responsibilities:

• Meet department and company performance and attendance expectations.
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Perform other duties as assigned.

SUCCESS PROFILE

Work Experience: At least five years of clinical experience required. Leadership experience in health insurance, provider organization, or closely related experience strongly preferred. Prior experience in a managed Medicaid setting in the Pacific Northwest is preferred. Significant senior management policy and decision-making experience, including developing and implementing management best practices preferred.

Education, Certificates, Licenses: Doctor of Medicine (MD or DO) with an unrestricted license to practice medicine by the Oregon State Board of Medicine while being eligible and willing to obtain licensure to practice medicine in Washington, Idaho, and Montana. Prefer board certification recognized by American Board of Medical Specialties (ABMS).

Knowledge: Comprehensive knowledge of business principles and techniques of administration, organization, and management to include an in-depth understanding of the key business issues that exist in the healthcare industry. These include, but are not limited to, quality improvement including, Lean methodology, healthcare economics, personnel administration, financial and cost analysis, trends in the healthcare industry, clinical documentation, and risk assessment. Excellent understanding of all areas of medical conditions, treatment, and care. Excellent understanding of the insurance industry and risk factors and how they relate to the PacificSource organization. Demonstrated skills with the following software: Microsoft word, PowerPoint, and Excel.

Competencies:

Authenticity

Building Organizational Talent

Cultivating Networks

Customer Focus

Empowerment/Delegation

Emotional Intelligence

Establishing Strategic Direction

Optimizin