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Associate Medical Director

Portland, OR, USA | Oregon Health & Science University Hospital

  • Industry:
    Healthcare - Hospitals
  • Position Type:
  • Functions:
  • Experience:
    5-7 years
Job Description:
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The OHSU Health Services Associate Medical Director supports the Chief Medical Officer (CMO) in the coordination, development, implementation and evaluation of quality and performance improvement programs for the value-based contracts managed by OHSU Health Services, including Medicaid, Medicare and commercial contracts. This position assists with oversight of the operations of medical management programs, including referrals/authorizations, utilization management, and clinical review decisions; the clinical pharmacy program; quality improvement; and credentialing, and participates on related committees.

The Associate Medical Director provides leadership for the development and implementation of quality improvement activities for OHSU Health Services and works with other members of the Health Services team and internal and external stakeholders to design programs that improve quality and control costs, including those related to improving performance on quality metrics and appropriate utilization of services.

The Associate Medical Director is encouraged to maintain a clinical, education and/or research role outside of this position. The Medical Director will maintain active staff privileges with at least one of the hospitals within the OHSU health system.

OHSU Health Services is committed to the ongoing journey of being an anti-racist organization that acknowledges the enduring impacts of historical injustices on health; addresses clinical, social, and structural conditions that undermine health and wellness; creates a culturally-proficient workplace that reflects the communities served; and fosters an environment of belonging, respect, and inclusion where everyone feels empowered and safe to bring their full, authentic selves to the work.

OHSU Health Services provides operational and management support to OHSU Health IDS, which serves approximately 50,000 Oregon Medicaid members who get their primary care within our network, and Tuality Health Plan Services, which serves Medicare and commercial members who are under value based arrangements within our network.

Function/Duties of Position

1. Transformation & Quality Strategy – Provide oversight of development, monitoring and reporting of annual TQS quality work plan. Hold owners accountable for completing milestones and project in timely fashion. Assist with overcoming barriers as identified. Submit progress reports and final report to quality committees, Boards and other bodies as indicated.

2. Quality improvement –Work closely with data and analytics, quality improvement, care management and clinical teams to identify opportunities and develop solutions to improve health outcomes and patient experience, decrease total cost of care and address disparities through innovative programs and partnerships with internal departments and community organizations. Provider oversight of quality proposal funding program.

3. Credentialing – Review provider and facility credentialing files for approval per policy. Organize and facilitate credentialing subcommittee, including peer review. Maintain confidentiality of the credentialing process.

4. Medical Management – Provide oversight of utilization management (UM) programs for medical and pharmacy benefits as applicable, including internal and external UM processes. Review appeals as second level reviewer for medical and pharmacy authorizations. Work closely with care management and UM teams to ensure seamless care and communication between teams and between medical and pharmacy benefits. Responsible for submitting regulatory reports as indicated.

5. Clinical Pharmacy Program – Provide oversight and management of the clinical pharmacy program, including using data to identify high risk populations that may benefit from clinical pharmacy interventions. Work with the Pharmacy Benefits Manager (PBM) to identify opportunities to improve access to medications that are result in the most cost-effective treatment that produces optimal outcomes.

6. Utilize proper telephone and personal etiquette and judicious use of other verbal and written communications, following OHSU and OHSU Health Services policies, procedures and guidelines. Follows OHSU and OHSU Health Services telecommuting policies and procedures. Perform other related duties as assigned.

Required Qualifications

Education: MD or DO from an accredited School or Medicine or School of Osteopathy.

Experience: Five or more years of clinical experience with direct patient care.

Three or more years of experience in development of one or more of the following: quality and performance improvement programs; healthcare policy; best practice implementation; or healthcare innovation/ transformation programs.

Registration, Certifications and/or Licenses: Maintains Oregon medical license.

Maintains Board certification in area of specialization.

Maintains active, courtesy, affiliate, or honorary staff membership in good standing with the medical staff of the hospital with all privileges and responsibilities accorded such membership.

Must be able to perform the essential functions of the position with or without accommodation.

Preferred Qualifications

Education: Additional Master’s degree in business administration, healthcare administration, public health or similar field.

Experience: Clinical or health plan leadership experience.

Training and/or experience in medical management, quality improvement or utilization management.

Additional Details

Job Related Knowledge, Skills and Abilities: Required:

• Expertise in performance improvement processes and use of data to identify opportunities and drive decisions.

• Ability to identify and understand needs, outcomes, and gaps for various stakeholders and community groups through data analysis, review and information gathering, and to develop and implement collaborative solutions.

• Problem-solving skills with the ability to look for the root cause of issues and implementable, workable solutions.

• Attention to detail and a track record of producing high-quality and accurate work that reflects well on the organization.

• Ability to drive results through indirect management of people and task, using influence, credibility, and vision.

• Skills and experience in organizing and presenting information, large and small group facilitation and public interaction with diverse, varied audience types and sizes.

• Creative- and critical-thinking skills with the ability to consider new ideas to improve care and outcomes.

• Ability to understand regulatory and contractual requirements and develop strategies to meet short and long term goals to better integrate and coordinate care

• Ability to drive results through indirect management of people and task, using influence, credibility, and vision.

• Excellent interpersonal and communication skills and ability to work successfully and be credible with all levels of management (Executive Team, Board of Directors) and with physicians, administrators, senior health care leaders, business leaders, partner organizations, community organizations, and other key stakeholders.

• Excellent verbal, written, analytical, planning, and organizational skills.

• Demonstrated ability to effectively represent OHSU Health Services on outside committees and organizations.

• Experience with data analytics, standard office equipment and programs, and Electronic Medical Records systems.

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