Executive Medical Director - Medical Management
Portland , OR, USA | Cambia
Industry:Healthcare - Health & Life Insurance
Job Description:124 people have viewed this job
At Cambia, our values are fundamental to achieving our Cause of transforming the health care industry. They guide our actions and bring diverse perspectives together to improve the health care journey better for those we serve. All eight values are equally important and linked to the others: Empathy, Hope, Courage, Trust, Commitment, Innovation, and Accountability. These values are not just words on paper - we live them every day.
Achieving our ambitious Cause requires exemplary leadership. In addition to the Cambia values listed above, our leaders demonstrate the following leadership attributes: Cambia leaders think big, push boundaries, envision possibilities, inspire and empower others. They build collaborative relationships beyond their functional area and create workplaces which are just and transparent. Our leaders must be lifelong learners, develop others and act as role models for their teams, colleagues, external partners and—most importantly—our current and future members.
Responsibilities & Requirements
As the Executive Medical Director for Medical Management, you will provide leadership to create and drive clinical and business strategies focused on improving clinical performance and outcomes throughout the health plan. Yourexceptional communication skills and a deep understanding of our clinical programs, provider therapeutics and new therapies will influence internal and external constituencies, drive change, and promote growth.
This role oversees and directs teams involved in medical management decisions to ensure members receive the right medical care at appropriate levels of cost and utilization with a focus on shared-decision-making and cost-effectiveness.
Provides leadership in management of utilization management and medical management and is the executive medical director that represents the company in these initiatives internally and externally.
Identify improvement opportunities and champion and drive change related to clinical outcomes, cost effectiveness and improved member experience.
Manage assigned departments, programs, line of business or vendor partnerships.
Manage physicians, clinical leaders and operational staff including hiring, performance management, development and retention and participate in talent planning discussions within Health Care Services.
Provides internal and external executive leadership to promote provider partnership and business growth with key stakeholders and accounts. Communicates in various forums as a medical and health plan subject matter expert.
May manage VIP cases and higher-level appeals.
Stays abreast of industry, medical and technology trends. Identifies and communicates new opportunities in utilization management, provider contracting or other areas that would enhance outcomes and the reputation of the organization.
Supervision of more than 100 FTEs.
Executive Medical Director would have a MD or DO degree (also prefer a MBA, MPH, or MHA degree), 5+ years clinical experience, plus 4+ years health plan managed care experience and leadership, sales and/or provider partnership experience, or equivalent combination of education and experience.
Demonstrated competency working with hospitals, provider groups, or integrated delivery systems to reduce healthcare costs and improve outcomes.
Excellent communication, influencing, presentation and facilitation skills with all levels of the organization and executive-level external partners, including the ability to creatively resolve complex issues, build consensus among groups of diverse stakeholders.
Proven ability to develop and maintain positive working relationships with provider, vendor, community and account partners.
In-depth knowledge of the health insurance industry, state and federal regulations, provider reimbursement methods and evolving accountable care and payment models. Proven capabilities to drive change related to population health and healthcare transformation.
Strong knowledge of health plan clinical practices, programs and processes.
General business acumen including understanding of market dynamics, financial/budget management, data analysis and decision making. Expertise in applying data and best practices to manage health and quality outcomes.
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.
Ability to effectively coach and manage others. Experience driving change and managing deliverables.
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