US-CA-West Hollywood
Req No 2019-10165
The California Managed Care Medical Director for the organizations Managed Care Division contributes to the mission by providing strategic and clinical leadership through oversight of clinical services. The MCMD ensures that the Mission, Core Values and Management Principles of the organization are reflected in the his/her daily execution of Medical Director duties.
The MCMD functions as a clinical leadership partner with the Chief of Managed Care. This position requires significant capacity to manage multiple competing objectives, to prioritize, and to communicate complex information in clear and unambiguous terms to management, cross-functional team members, end user personnel and medical providers within the health plan and organizational networks.
The MCMD oversees all medical care for the health plan's products and services, the health care needs of the membership and serves as the principal medical manager and policy advisor to the company and health plan Chief of Managed Care. The MCMD is accountable for and provides professional leadership and direction to the utilization/cost management, clinical quality management and risk adjustment functions. The MCMD works collaboratively with other plan functions that interface with medical management such as provider relations, member services, benefits and claims management, etc.
The MCMD assists in short and long range program planning, total quality management (quality improvement) and external relationships. The MCMD Works with the Department of Medicine, Finance and other departments to provide support, assistance and direction in overall medical management effectiveness for the health plans and specific grant contracts The MCMD reports all issues of clinical quality management to the health plan Chief. The MCMD reports clinical quality, utilization and risk adjustment activities to the Managed Care Executive Committee. Collaborates with the Chief of Medicine and other external health plan medical directors on health plan national medical policies. Carries out national medical policies at the health plan in collaboration with the health plan Chief of Managed Care and Managed Care Directors.
TO APPLY
Submit resume along with compensation requirements in complete confidence to Amanda Sonus at asonus@pailingroup.com
