Interim Executive Medical Director

Oregon Health & Science University • Portland, OR

7d

About The Position

Department Overview Health Services functions and an MSO and oversees the OHSU Health IDS and OHSU Health CIN. The IDS is a fully capitated Medicaid plan with 61k members. The CIN holds MSSP ACO and other VBC contracts and manages the operations and oversight of those VBC contracts. This interim position is established to provide critical continuity and stabilization for the Health Plan Services team during a period of physician leadership transition. This role is intended to provide physician leadership for clinical, operational, compliance, and strategic initiatives and processes. This leader will also play a key role in working with the Health Plan Services leadership team to evaluate and update the future physician leadership needs of Health Plan Services in terms of title, scope, and FTE. Within 90 to 180 days (about 6 months), the findings of the physician leadership evaluation will be operationalized though the posting of one or more permanent positions. The Interim Medical Director, Health Plan Services is a senior executive responsible for leading the clinical performance and partners with the CAO on the development of the strategic direction of the high performing Networks that are foundational to the OHSU Health IDS and Tuality Health Plan Services (THPS). The Interim Medical Director partners with the Chief Administrative Officer (CAO), Health Plan Services, together, they are responsible for ensuring operational excellence and strategic fine tuning aimed at improving the quality, efficiency and financial sustainability of care delivered via OHSU Health networks, as measured by well- established clinical quality (HEDIS, Stars etc.) and financial metrics (loss ratios, percent of premium targets etc.). Health Plan Services will serve as a Management Services Organization (MSO) supporting value-based Networks affiliated with the OHSU Health System. The Interim Medical Director will work collaboratively with OHSU Health system leadership in developing high performing networks for Medicaid, Commercial, Medicare Advantage and/or Direct to Employer relationships that improve the health status of those populations in sustainable economic models and partnerships that support care transformation. Collaboration with payors and across the organization to achieve OHSU Health’s objectives will be critical. Linking payer and provider network initiatives with those of the Office of Primary Care & Population Health will also be essential to support OHSU’s focus on the quadruple aim (improved quality and consumer experience, reduced cost, increased provider satisfaction). The Interim Medical Director also provides the executive clinical leadership necessary to advance OHSU’s Clinically Integrated Network (CIN). This role is responsible for aligning clinical strategy with operational goals, ensuring federal regulatory compliance for the Medicare Shared Savings Program (MSSP), and driving the "last mile" of value-based contracting. The Interim Medical Director and CAO will be responsible for working with leadership to set meeting agendas, present content, and to develop programs to provide MSO services, enhance quality and assure clinical integration of the IDS, THPS and other value-based networks within OHSU and with Payors as applicable. Responsible for working with the Office of Payor Strategy and OHSU Health System leadership to achieve mutual goals, as well as with the Health Share of Oregon Coordinated Care Organization and state-level workgroups and committees.

Requirements

• MD or DO from an accredited School or Medicine or School of Osteopathy
• Five or more years of physician management experience, including any combination of the following: health plan operations/leadership, and/or Integrated Delivery Systems, including population health, value-based care delivery, chronic care or other clinical care improvement program development which demonstrates leadership skills with an emphasis on a collaborative style.
• Maintains Oregon medical licensure
• Maintains active, courtesy, affiliate, or honorary staff membership in good standing with the medical staff of the hospital with all privileges and responsibilities accorded such membership
• Job Related Knowledge, Skills and Abilities (Competencies): Demonstrated leader with expertise in caring for diverse and specialty patient populations within complex healthcare systems. Recognized for strong interpersonal and communication skills, with the ability to engage effectively across diverse cultural backgrounds and navigate both routine and high-stakes situations with patients, families, physicians, and interdisciplinary teams. Proven ability to build credibility and collaborate successfully with physicians in solo and group practices, as well as with executive leadership, Boards of Directors, administrators, and business leaders. Experienced in delivering effective presentations to small and large audiences. Exceptional leadership and management capabilities, with a track record of building and guiding high-performing teams in dynamic environments. Strong analytical, organizational, and strategic planning skills, including experience in data analytics, EMR systems, healthcare technology, and standard business tools. Comprehensive knowledge of Medicare, Medicaid, and the Oregon Health Plan, with an understanding of healthcare budgeting, utilization management, and chronic care protocols. Effectively represents OHSU Health System in local and national forums, demonstrating professionalism, strategic insight, and organizational stewardship.

Nice To Haves

• Master's degree in business administration, healthcare administration, public health or similar field
• Background in medical case management

Responsibilities

• Payor strategy and health plan relationships Works CAO and OHSU Leadership teams to understand trends in the marketplace and create responses to those, liaison between OHSU Health System and community providers Acts as liaison with Health Plans and Insurance company Medical Directors when appropriate. Participates actively with the physicians of the plan and with other organizations to achieve mutual goals of the managed care marketplace. Works closely with appropriate payor partners in joint operation of the Medicaid IDS, THPS and other networks, as applicable. Supports OHSU Health in value-based contracting and improvements in risk-based infrastructure and data-driven technology. Maintains an in depth understanding of healthcare trends, especially concerning value-based networks, academic medical center’s roles in population health and care transformation serving communities.
• Value-based contract Management and Performance Responsible for the development and operation of comprehensive management services necessary to efficiently operate OHSU Health’s value- based networks including Clinically Integrated Networks, risk-based, IDS, MSSP, Direct-to-Employer and other value-based networks. Responsibility includes collaboration and leadership with payor partners providing some/all management services to OHSU networks (for example, Moda Health’s management services to the IDS serving Health Share). Provides leadership and management for the development of OHSU value- based network strategies and implementation, including care management, utilization management and pharmacy management programs. Coordinates program activities with the physician committees. Supports innovation and process improvement by identifying best practices from across the country and incorporating them into OHSU’s value-based networks. Oversee the clinical definitions within VBC contracts, ensuring that quality metrics and appropriateness targets are sustainable, protective of provider well-being and drive shared savings. Make medical necessity decisions as required for referrals and pre-authorizations.
• Provider network Collaborate with the CAO to ensure that the health plans’ financial objectives are achieved through clinically sound strategies. Communicates OHSU Health Plan Operations goals, objectives and policies to the physician members in a wide variety of specialties of the applicable value-based networks and boards Oversees credentialing process for Health Plan Operations and appointment to the applicable value-based network panel to assure compliance with policies and procedures. Coordinates these activities with other OHSU departments and payors as necessary to ensure OHSU Health providers are credentialed and appropriately added to OHSU value-based networks in a timely manner. Assess quality and appropriateness of care provided by providers in OHSU value-based networks and respond accordingly. Able to foster leadership in the OHSU Health network, actively reinforcing the positive aspects of quality improvement activities.

What This Job Offers

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