Associate Medical Director or Medical Director DOE

Cambia Health Solutions • Salt Lake, UT

32d • Hybrid

About The Position

Every day, Cambia’s dedicated team of physicians are living our mission to make health care easier and lives better. As a member of the Physician Review team, our Associate Medical Director and Medical Directors physicians will participate in utilization management and provide clinical leadership and support to clinical teams to ensure our members receive quality, cost effective care yielding optimal outcomes – all in service of creating a person-focused health care experience. Are you a motivated and experienced medical professional looking for a new challenge? Do you have a passion for patient care and want to make a big difference in healthcare? Then this role may be the perfect fit.

Requirements

• Licensed Physician with an MD or DO degree
• Minimum 3 years clinical experience, or equivalent combination of education and experience.
• Active, unrestricted license to practice medicine in one or more states or territories of the United States, with one of these licenses in our four-state area (OR, WA, ID, UT).
• Applicant must also live in four state area.
• Board Certification required.
• Qualification by training and experience to render clinical opinions about medical conditions, procedures and treatments under review.
• Demonstrated competency working with hospitals, provider groups or integrated delivery systems to effectively manage patient care to improve outcomes.
• Strong communication and facilitation skills with internal staff and external stakeholders, including the ability to resolve issues and seek optimal outcomes.
• Proven ability to develop and maintain positive working relationships with community and provider partners.
• Knowledge of the health insurance industry, state and federal regulations, provider reimbursement methods and evolving accountable care and payment models.
• General business acumen including understanding of market dynamics, financial/budget management, data analysis and decision making.
• Strong orientation to the application of data in managing health and quality.
• Proven ability to develop creative strategies to accomplish goals and objectives, plan and execute complex projects and programs and drive results across internal teams and/or external partners.
• Demonstrated ability to effectively lead and engage in a constructive manner with others.

Nice To Haves

• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired.

Responsibilities

• Provides clinical leadership for staff to ensure members receive safe, effective and cost efficient services.
• Contributes to the development of various medical management strategies and tactics to drive results and achieve key performance metrics.
• Conducts peer clinical review for medical necessity on utilization management authorization requests.
• Provides clinical input on case management reviews working closely with the CM clinical staff.
• Responsible for discussing review determinations with providers who request peer-to-peer conversations.
• Participates on multiple teams to provide clinical input on medical policy reviews and development and may participate on committees that develop programs impacting clinical interventions, utilization management and case management.
• Analyzes and uses data to guide the development and implementation of health care interventions that improve value to the member and employer.
• Advises Health Care Services Leaders on related key performance metrics and the effectiveness of various efforts, initiatives, policies and procedures.
• Identifies and communicates new opportunities in utilization management, provider contracting or other areas that would enhance outcomes and the reputation of the organization.
• Provides clinical expertise and coordinates between internal clinical programs and providers of care to improve the quality and cost of care delivered to health plan members.
• Ensures ethical decision making in compliance with contractual arrangements, regulations and legislation.
• Supports internal communication or training that ensures service is provided to members and providers by a well-trained staff.
• Promotes provider understanding of utilization management and quality improvement policies, procedures and standards.
• Provides guidance and oversight for clinical operational and clinical decision-making aspects of the program.
• May participate in health plan credentialing operations and clinical aspects of the credentialing program and provider services support.

Benefits

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Ph.D. or professional degree