Medical Director – Benefit/Utilization Management

🔥 5 minutes ago

🌲 Oregon – Remote

🌲 Oregon – Remote

💵 $294.6k - $360k / year

⏱ Part Time

🔴 Lead

👨‍⚕️ Medical Director

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CareOregon

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1994

🏥 Healthcare

📦 Logistics

🛡️ Insurance

Healthcare • Logistics • Insurance

CareOregon is a community-focused health plan that provides coordinated physical, behavioral, dental and social-support services to Oregon Health Plan members, serving more than 500,000 people. The organization operates provider and member portals, offers care coordination, telehealth, language and tribal services, community grants and outreach, and programs addressing social determinants of health such as housing, nutrition and transportation.

📋 Description

• Oversee clinical and wellness programs and initiatives supporting CareOregon members • Develop, implement, and manage clinical and wellness programs with the Senior Medical Director • Direct and oversee utilization, case, disease, and quality management programs • Develop and implement physician education programs regarding quality and utilization management • Represent the health plan in medical and professional organizations • Enhance CareOregon’s image within the community • Serve as medical spokesperson for Coordinated Care Organizations, contract negotiations, and provider expansion activities • Provide leadership through open communication and delegation of responsibilities and authority • Provide medical support for Care Management/Care Coordination activities • Provide medical director oversight, benefit determinations, and medical and pharmacy appeals • Collaborate with CCO/Line of Business Medical Directors on clinical strategy and interventions • Educate network providers on best clinical practices using population/panel management and performance data • Work from home while using general office equipment and potentially traveling outside the workplace

🎯 Requirements

• Board-certified medical doctor or doctor of osteopathy in one of the primary care specialties, including obstetrics/gynecology • Licensed physician (MD or DO) in the State of Oregon • Minimum 3 years’ physician experience • Minimum 4 years’ experience in a supervisory position (preferred) • Benefit/utilization management experience (preferred) • Leadership experience, preferably including managed care, quality assurance, utilization review, and case management • Clinical knowledge of management of diverse medical problems • Basic knowledge of regulatory and contractual requirements for Medicaid, Medicare, and commercial insurance • Understanding of managed care operations • Familiarity with guideline development, outcomes management, population health improvement, disease management, cost effectiveness, and cost analysis studies • Knowledge of physician/provider payment issues, physician practice models, total quality, and continuous quality improvement concepts • Medical policy knowledge and skills related to quality, case and disease management, credentialing activities, and utilization management • Excellent communication and collaboration skills • Ability to implement clinical and wellness programs for high-risk members • Ability to work effectively in cross-functional teams and with diverse individuals and groups • Ability to plan, set priorities, delegate effectively, and utilize time efficiently • Skills in quality management techniques in a large, organized managed care setting • Commitment to improving access and quality of care for underserved and uninsured populations • Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day • Ability to hear and speak clearly for at least 3–6 hours/day

🏖️ Benefits

• 0.8 position with benefits • Bonus opportunity; Bonus - SIP Target, 10% Annual • Medical, dental, and vision insurance • Life, AD&D, and disability insurance • Health savings account • Flexible spending account(s) • Lifestyle spending account • Employee assistance program • Wellness program • Discounts • Supplemental benefits including voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, and 529 College Savings • Retirement plan with employer contributions • PTO • Paid State Sick Time • Paid holidays • Volunteer time • Jury duty leave • Bereavement leave • 401(k) contributions • Occasional travel may be required or optional