Category: Managed Care. Regular Full-Time
Core Values
YOUR CONTRIBUTION TO THIS EMPLOYER’S SUCCESS! The California Managed Care Medical Director for the Managed Care Division contributes to the mission by providing strategic and clinical leadership through oversight of clinical services. The MCMD ensures that the Corporate Mission, Core Values, and Management Principles of the organization are reflected in his/her daily execution of Medical Director duties. The MCMD functions as a clinical leadership partner with the Chief of Managed Care. This position requires significant capacity to manage multiple competing objectives, prioritize, and communicate complex information in clear and unambiguous terms to management, cross-functional team members, end-user personnel, and medical providers within the health plan and networks.
The MCMD oversees all medical care for the health plan's products and services, the healthcare needs of the membership, and serves as the principal medical manager and policy advisor to the company and health plan Chief of Managed Care. The MCMD is accountable for and provides professional leadership and direction to the utilization/cost management, clinical quality management, and risk adjustment functions.
The MCMD works collaboratively with other plan functions that interface with medical management such as provider relations, member services, benefits, and claims management. The MCMD assists in short- and long-range program planning, total quality management (quality improvement), and external relationships. The MCMD works with the Department of Medicine, Finance, and other departments to provide support, assistance, and direction in overall medical management effectiveness for the health plans and specific grant contracts. The MCMD reports all issues of clinical quality management to the health plan Chief.
The MCMD reports clinical quality, utilization, and risk adjustment activities to the Managed Care Executive Committee. Collaborates with the Chief of Medicine and other external health plan medical directors on health plan national medical policies. Carries out national medical policies at the health plan in collaboration with the health plan Chief of Managed Care and Managed Care Directors.
TO APPLY
Please forward current resume/CV to Amanda Sonus at asonus@pailingroup.com
Pailin Group Executive Search Consultants – Retained executive search worldwide.
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