L&I Associate Medical Director (Physician 3), Network Quality

State of Washington•Multiple Locations Statewide, WA

1d•Remote

About The Position

Within Insurance Services, the Office of the Medical Director (OMD) is responsible for L&I’s statewide health policy to ensure that injured and ill workers have access to high quality, evidence-based care and that services paid for by the workers compensation Medical Aid Fund are clinically appropriate and cost effective. This position will provide clinical input that contributes to a wide range of goals and activities – from rendering clinical advice on individual complex claims to developing, interpreting, and applying health policies such as medical treatment guidelines; providing professionally accredited continuing medical education seminars; and participating in public-private collaborations to address statewide, systemic health issues such as variability in delivery, utilization, and cost of services. The Department of Labor & Industries (L&I) is a diverse state agency dedicated to the safety, health, and security of Washington's workers. We help employers meet safety and health standards and inspect workplaces when alerted to hazards. As administrators of the workers' compensation system, we are similar to a large insurance company, providing medical and limited wage-replacement coverage to workers who suffer job-related injuries and illness. Our rules and enforcement programs also help ensure workers are paid what they are owed, that children's and teens' work hours are limited, and that consumers are protected from unsound business practices. Insurance Services is the largest division within the agency and administers one of the premier workers’ compensation organizations in the nation serving over 3.8 million employees working for 260,000 employers.

Requirements

Valid State of Washington Medical License.
Board certification in a medical specialty relevant to common workers’ compensation disorders, e.g. occupational medicine, rehabilitation medicine, orthopedic surgery, internal medicine.
Minimum of five (5) years practice experience post-residency
Minimum of three (3) years experience in health care leadership, e.g. institutional, professional society, state or county medical society
Excellent verbal and written communication skills, especially with professional colleagues; skilled in developing respectful, trusting, collaborative relationships, and actively resolving conflict.
The ability to take action to learn and grow.
The ability to take action to meet the needs of others.

Nice To Haves

Master’s degree in Public Health or related public health field such as epidemiology, health administration, or health services research.

Responsibilities

Provide leadership of the L&I credentialing committee to; review providers applying to join L&I’s Medical Provider Network; conduct ongoing credentialing review activity, which includes formulating credentialing committee strategy, policy, and procedures to ensure process integrity.
Participate in the development of evidence-based policies and guidelines.
Provide clinical expertise and direct claims support to improve and promote the quality of care received by injured and ill workers.
Provide epidemiological and clinical expertise for health policy development and analysis, and program development and implementation.
Provide medical leadership and consultation on issues of causality, appropriate medical care, credentialing of network providers, risk of harm standards, quality assurance, and other clinical health policy programs.
Provide guidance on analyses related to billing policy and fee schedules, provider qualifications, provider review and profiling, utilization review, statutory and regulatory review and review of clinical services, including tests and treatments with wide variation or quality concerns and emerging technologies
Participate, coordinate, and consult on the formulation and implementation of health care law, rules, and policies
Work as a liaison and provide professional guidance and educational expertise with clinicians, clinical associations, advisory committees, business and labor organizations, and other stakeholders.
Educate and train on medical policies and procedures.
Participate in or consult on quality and outcomes research projects.