Medical Director – Benefit/Utilization Management

🔥 20 hours 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/or quality management programs • Educate participating physicians and network providers on quality management, utilization management, best clinical practices, population/panel management, and performance data • Represent the health plan in medical and professional organizations and community activities • Serve as medical spokesperson supporting CCOs, contract negotiations, and provider expansion activities • Provide leadership to maintain a motivated, productive, and competent team • Provide medical support for Care Management/Care Coordination activities • Provide medical director oversight, benefit determinations, and appeals for medical and pharmacy • Collaborate with CCO/LOB Medical Directors on clinical strategy and interventions • Implement programs addressing the needs of high-risk members and improving care and service quality

🎯 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 experience • Knowledge of clinical 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, and utilization management • 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, vision, 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 for non-benefits eligible employees • Work from home