Medical Director - Benefit/Utilization Management

CareOregon•Portland, OR

4d•$294,570 - $360,030•Remote

About The Position

This position is responsible for oversight of clinical and wellness programs and initiatives in support of CareOregon members. Areas of focus may include benefit management, benefit utilization, quality assurance, case management, disease management, pharmacy, or other areas. This is a 0.8 position with benefits. The hiring range listed would be pro-rated to reflect 0.8.

Requirements

Board-certified medical doctor or doctor of osteopathy in one of the primary care specialties, including obstetrics/gynecology (Internal Medicine, Family Practice, Emergency Medicine, or Pediatrics preferred)
Licensed physician (MD or DO) in the State of Oregon
Minimum 3 years’ physician experience

Nice To Haves

Minimum 4 years’ experience in a supervisory position
Benefit/utilization management experience
Leadership experience, preferably to include managed care, quality assurance, utilization review and case management experience

Responsibilities

With the Senior Medical Director, develop, implement and manage clinical and wellness programs to address the needs members.
Implement, direct and oversee utilization, case, disease, and/or quality management programs.
Develop and implement programs for educating participating physicians regarding quality management and utilization management issues.
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 Coordinated Care Organizations (CCOs), contract negotiations and other provider expansion activities.
Provide leadership necessary to maintain a motivated, productive and competent team through open communication and delegation of responsibilities and authority.
Provide medical support for Care Management/Care Coordination activities.
Provide medical director oversight, benefit determinations and appeals for medical and pharmacy as assigned by Senior Medical Director.
May integrate with CCO/Line of Business (LOB) Medical Directors to develop, implement, direct, and oversee programs that provide clinical strategy and interventions to CCO/LOB clinical systems.
Support and implement programs for educating network providers regarding best clinical practice using of population/panel management and performance data on clinical quality and utilization.

Benefits

medical, dental, vision, life, AD&D, and disability insurance
health savings account
flexible spending account(s)
lifestyle spending account
employee assistance program
wellness program
discounts
multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.)
strong retirement plan with employer contributions
PTO
Paid State Sick Time
paid holidays
volunteer time
jury duty
bereavement leave