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Senior Medical Director

Portland, OR, USA | American Hospital Association

  • Industry:
    Healthcare - Hospitals
  • Position Type:
    Full-Time
  • Functions:
    Biotech/R&D/Science
  • Experience:
Job Description:
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Provides leadership in development and oversight of medical policies, clinical programs, and competitive strategies to improve clinical performance and achieve business objectives.  

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 partnership.

Manage staff including hiring, training/onboarding, performance management, development and retention and may participate in talent planning discussions within Health Care Services.

Provide internal leadership to promote medical management initiatives. Communicate in various forums as a medical and health plan subject matter expert.

Management of high visibility escalations, executive inquires and support of applicable high-cost claimants. 

Participate in external/internal audits 

Stays abreast of Regulatory and Accreditation Standards (including ERISA standards), 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.



Minimum 

Requirements


Physician (M.D. or D.O) with a current and unrestricted physician license in a state or territory of the United States

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 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, including reimbursement methodology, and benefit management.

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 manage a team and achieving results through people.

Demonstrated ability to independently make tough strategic decisions and move forward with actions on the strategies.

Proactive, results oriented and demonstrated ability to meet deadlines under pressure.

Proficiency in computer use including software applications such as Microsoft Office Products, and systems used for electronic documentation of case reviews.

Preferred experience 

Experience developing medical policies 

Management of utilization management business function


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