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Career Opportunities: Medical Director - Clinical Services (24536) Requisition ID 24536 - Posted 08/21/2024 - CareOregon - Full Time - Permanent - Portland - Multi Location (2) Job Description Print Preview Job Title Medical Director - Clinical Services Department Medical Management Administration Exemption Status Exempt Requisition # 24536 Direct Reports N/A Manager Title Sr Medical Director - Clinical Services Pay & Benefits Estimated hiring range $283,150 - $346,000/year, 10% bonus target, full benefits. www.careoregon.org/about-us/careers/benefits Posting Notes This role will focus on achieving better quality of care for a special needs, dually eligible Medicare population by understanding and applying D-SNP Medicare regulatory requirements, and in partnership with our network providers, develop a clinical strategy to improve population health, coordinate care, and meet CMS STARS measures. Job Summary This position is responsible for leading a multidisciplinary, matrixed team in supporting both internal staff, as well as external network and other partners, in implementing effective care management, quality, and other clinical practice improvement initiatives as assigned, in support of the Quadruple Aim. Direct support may be focused on Medicaid or Medicare lines of business in a Coordinated Care Organization (CCO) environment. Work includes four key areas: Best practices and network support with focus on integration (physical health, behavioral health, oral health, social health) Data support and translation with focus on quality improvement Population health framework including strong equity focused approach and resource stewardship for vulnerable populations (including value-based payments) Regional relationships and collaboration in a CCO environment This position may be assigned to lead medical management, clinical informatics, behavioral health, and/or population health initiatives for the organization including clinical quality in the provider network. Essential Responsibilities In partnership with the Senior Medical Director and/or other Medical Directors, develop, implement, and manage clinical programs to address member needs. Implement, direct, and oversee utilization, case, disease, and/or quality management programs. Develop and implement programs for supporting participating physicians in optimizing quality management and utilization management. Represent the health plan in applicable activities including medical and other professional organizations; participate in activities that enhance CareOregon's image within the community. Serve as a representative and medical spokesperson for the plan in support of CCOs, Medicare, contract negotiations and/or other provider expansion activities. Provide medical support for Care Management activities. Provide oversight of benefit determinations and appeals for medical and pharmacy as assigned by Senior Medical Director or CMO. May partner with CCO leadership team to develop, implement, direct, and oversee programs that provide clinical strategy and interventions to CCO clinical systems. May plan, participate in, or lead CCO Clinical Advisory Panel (CAP), depending on CCO/regional needs. Support and implement programs for network providers to share best clinical practice using of population / panel management and performance data on clinical quality and utilization. Organizational Responsibilities Perform work in alignment with the organization's mission, vision and values. Support the organization's commitment to equity, d