Job Title

　　Associate Medical Director – Clinical Services CPCCO

　　Exemption Status

　　Exempt

　　Department

　　Medical Management Administration

　　Manager Title

　　Medical Director, CPCCO

　　Direct Reports

　　n/a

　　Requisition #

　　24024

　　Pay and Benefits

　　Estimated hiring range is $109.26 to $132.21 per hour. This is a part-time, salaried role. 5% bonus target, full benefits. www.careoregon.org/about-us/careers

　　Posting Notes

　　This is a hybrid position with a flexible schedule of 0.5 FTE. Travel will be needed between Multnomah, Tillamook, Clatsop, and Columbia counties.

　　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 CCO Medical Director, Senior Medical Director and/or other Medical Directors, and teams, 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 CCO Medical Director, 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 and participate in CCO Clinical Advisory Panel (CAP) as an informal leader or member, 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, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.

　　Strive to meet annual business goals in support of the organization’s strategic goals.

　　Adhere to the organization’s policies, procedures and other relevant compliance needs.

　　Perform other duties as needed.

　　Experience and/or Education

　　Required

　　Board-certified medical doctor or doctor of osteopathy in one of the primary care specialties, including obstetrics/gynecology (Internal Medicine, Family Practice or Pediatrics preferred)

　　Licensed physician (MD or DO) in the State of Oregon

　　Leadership experience in a managed care organization or practice setting, including, or following strong clinical practice activity

　　Preferred

　　Administrative graduate degree, certificate of educational achievement in medical administration, or equivalent

　　Experience working with a managed care organization

　　Knowledge, Skills and Abilities Required

　　Knowledge

　　Medical policy knowledge and skills as related to quality, case and disease management, credentialing activities and utilization management

　　Clinical knowledge of the management of diverse medical problems, including impact of social concerns

　　Understanding of health equity and ways social inequities impact health

　　Basic knowledge of applicable 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 and cost effectiveness and cost analysis studies

　　Awareness of physician/provider payment issues, physician practice models and total quality and continuous quality improvement concepts

　　Skills and Abilities

　　Excellent communication and collaboration skills for work with network providers and internal employees; ability to effectively express ideas and gain acceptance

　　Ability to implement new and improved approaches to improvement of care and service quality, and to Care Management activities performed by CareOregon

　　Ability to implement clinical and wellness programs to address the needs of high-risk members

　　Ability to create excitement and bring individuals and teams together into a cohesive unit

　　Ability to lead and/or work effectively as part of a cross-functional, matrixed team and foster an environment where change is embraced and supported

　　Ability to deal with issues and problems systemically

　　Ability to plan, set priorities, delegate effectively and utilize time efficiently

　　Experience applying innovative and creative approaches to improve health care delivery

　　Skilled in quality management techniques in a large, organized managed care setting

　　Commitment to improving access and quality of care to the underserved and uninsured

　　Appreciation of cultural diversity and the needs of serving a diverse patient population

　　High degree of diplomacy, credibility, and persuasiveness to consistently cultivate effective working relationships

　　An organized, disciplined, hands-on and process-oriented leader

　　Results-oriented decision-maker with the ability to balance diverse priorities

　　Proactive and action oriented; ability to drive performance

　　Ability to work effectively with diverse individuals and groups

　　Ability to learn, focus, understand, and evaluate information and determine appropriate actions

　　Ability to accept direction and feedback, as well as tolerate and manage stress

　　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

　　Working Conditions

　　Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure

　　Member/Patient Facing: ☐ No ☒ Telephonic ☐ In Person

　　Hazards: May include, but not limited to, physical and ergonomic hazards.Equipment: General office equipment

　　Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used.

　　#Li-Hybrid

　　Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment.

　　Veterans are strongly encouraged to apply.

　　We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.

　　Visa sponsorship is not available at this time.