Clipped from: https://www.learn4good.com/jobs/tulsa/oklahoma/healthcare/1887844755/e/
Medical Management – Medical Director Medicaid 145-2047
Tulsa, OK, USA Req #75
Saturday, December 10, 2022
JOB SUMMARY:
The Medicaid Medical Director will serve as an organizationally focused leader and have primary responsibility for assisting the Senior VP & Chief Medical Officer in designing, building, and operating the Medical Management functions for Medicaid. This clinician will additionally have responsibility for Medicaid care management and utilization management operations in conjunction with other leaders. This key role sets the tone and provides leadership to a large team of nurses and support staff in support of numerous initiatives and function and in pursuit of optimal patient care and population health.
Places emphasis on quality improvement, member experience and safety, and designs programs in support of this effort.
KEY RESPONSIBILITIES:
- Provide leadership and primary responsibility for Medicaid Medical Management functions.
- In cooperation with other leaders and stake holders understand state Medicaid program requirements and guide Medicaid operations to ensure program compliance and functioning ls.
- Provide oversight for clinical operations and decision making for the Community Care programs.
- Work with teams of nurses on pre-authorization and care management functions and initiatives.
- Support and guide quality improvement activities and develops programs for strategic implementation.
- Management of and/or participation in internal company committees as directed.
- The Medical Director is available for real time consultation with the initial clinical reviewers.
- Perform timely and responsive Peer to Peer reviews.
- Develop and maintain effective working professional relationships with medical and operational leaders of participating Medicaid provider organizations. The individual will strive to maintain excellent levels of communications with the networks and their related medical group, management, and quality staff.
- Develop and maintain effective working professional relationships with engaged community benefit organizations participating in the Medicaid network.
- Perform other special projects and duties as directed by the executive staff of Community Care Managed Healthcare Plans.
QUALIFICATIONS:
- Ability to effectively lead, direct and supervise others.
- Ability to converse and write fluently in English.
- Successful completion of Health Care Sanctions background check.
EDUCATION/
EXPERIENCE:
- Graduation from accredited medical school with residency-training in a relevant specialty with a minimum 5 years work clinical experience in their field.
- Current and active unrestricted license to practice medicine in the State of Oklahoma.
- Demonstrated leadership ability and experience in complex medical organizations required.
- Post-graduate management training or advanced degree is a plus, but not a requirement.
- Proven experience in data analysis, quality improvement processes, and/or practice transformation work a plus but not required.
- Must be board certified and maintain certification.
- Experience at health plan company preferred, but not required.
Community Care is an equal opportunity riminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin