Medical Consultant

DHRM•Richmond, VA

5d•Hybrid

About The Position

The Department of Medical Assistance Services (DMAS) is excited to offer a competitive opportunity to serve as the Medical Consultant in the office of the Chief Medical Officer. Job responsibilities will include, but are not limited to: The Medical Consultant provides support of the Agency's mission and advances key initiatives to achieve the quadruple aim of improved population health, reduced per capita cost, and enhanced patient and provider experience for Virginia’s Medicaid Program. This position will provide clinical direction and execute high-priority initiatives for the agency with the goal of providing high-quality and cost-effective health services to improve the health and well-being for Virginians in the Medicaid program. The individual in this position will represent Virginia Medicaid at internal and external meetings including working closely with the Medicaid provider community on high-priority initiatives. High-priority initiatives may include maternal and child health, vaccinations, pharmacy innovation, telehealth and rural health transformation. The Medical Consultant will lead synchronization of policy (state health plan, Code of Virginia, Administrative Code), payment (fee schedule maintenance, managed care payment, value-based care) and practice (clinical guideline development, medical policy coverage decisions). Completion of Medical School and an approved residency is required, ideally in Internal Medicine, Family Medicine, OB/GYN, Pediatrics, Emergency Medicine or Psychiatry. Must have working knowledge of the health needs of the Medicaid population. The business needs for this position may be completed virtually. The position you are applying for is an Hourly/Wage position. Hourly (wage) employees may not work more than an average of 29 hours a week and cannot exceed 1500 hours during their employment year. This position does not include health insurance, retirement or leave. Located in beautiful Central Virginia, the Richmond area puts you just 2 hours from the Blue Ridge Mountains, Virginia Beach and Washington DC. To learn more about the Richmond, VA area visit: https://www.virginia.org/ The Department of Medical Assistance Services (DMAS) is working to improve the health and well-being of Virginians through access to high-quality health care coverage. DMAS wants talented individuals who can align their experience with the mission of the agency and its core values – service, collaboration, trust, problem solving and adaptability. At the Department of Medical Assistance Services (DMAS) we encourage and promote that you Come as you are | Become who you want to be | That is our promise.

Requirements

Experience developing, implementing, and evaluating health care programs, including work with Medicaid payer or MCO operations.
Knowledge of Utilization Management and Medical Necessity Review systems and willingness to be trained on Utilization management platforms and processes.
Experience with project management processes, agency service procedures, and operational workflows for large programs.
Experience planning and executing projects and representing the agency on workgroups or taskforces.
Experience with Teams, Excel, Microsoft.
Knowledge of Medicaid policies and experience interpreting federal and state regulations.
Experience meeting strict deadlines on high-visibility or large-scale initiatives.
Experience collaborating with stakeholders across agencies, taskforces, and Medicaid payer organizations.
Completion of Medical School and an approved residency is required, ideally in Internal Medicine, Family Medicine, OB/GYN, Pediatrics, Emergency Medicine or Psychiatry.
Working knowledge of the health needs of the Medicaid population.

Nice To Haves

Knowledge of healthcare financing.
Experience working in/with Academic institutions.

Responsibilities

Provides support of the Agency's mission and advances key initiatives to achieve the quadruple aim of improved population health, reduced per capita cost, and enhanced patient and provider experience for Virginia’s Medicaid Program.
Provides clinical direction and executes high-priority initiatives for the agency with the goal of providing high-quality and cost-effective health services to improve the health and well-being for Virginians in the Medicaid program.
Represents Virginia Medicaid at internal and external meetings including working closely with the Medicaid provider community on high-priority initiatives.
Leads synchronization of policy (state health plan, Code of Virginia, Administrative Code), payment (fee schedule maintenance, managed care payment, value-based care) and practice (clinical guideline development, medical policy coverage decisions).