Medical Director

Full-time - Senior

Helena, MT

Ambulatory Health Care Services

About the position

Join PacificSource and help our members access quality, affordable care! Under the leadership of the Senior Medical Director, the Medical Director is responsible for the management of the PacificSource Commercial, Medicare, and Medicaid Lines of Business. This position will work closely with the Vice Presidents of each Line of Business in addition to other internal and external stakeholders to both develop and support initiatives in support of our membership and provider partners.

Responsibilities

• Review and make clinical determinations on coverage for pre- or post-service requests in accordance with evidence-based guidelines, CMS coverage guidelines to include the Medicare Benefit Policy Manual, National Coverage Determinations (NCD), and Local Coverage Determinations (LCD) in addition to internal PacificSource policies.
• Collaborate with stakeholders across the organization to create and drive clinical and business strategies focused on improving clinical performance, member experience, trend management, and quality.
• Participate actively in various external and internal committee meetings as assigned.
• Develop strategy and engage with regulatory entities to fulfill obligations and execute on contractual commitments associated with the line of business.
• Lead clinical activities connected to PacificSource's growth for each line of business and participate as a key leader.
• Participate in other clinical or administrative oversight, planning or management as designated from time to time.
• Work with the Senior Medical Director and the Chief Medical Officer on various projects as assigned.
• Coordinate business activities by maintaining collaborative partnerships with key departments.
• Actively participate in the organization as a team member and physician leader at all times.
• Understand and apply knowledge of risk adjustment and hierarchical condition categories as it relates to clinical documentation and engage in continuous improvement strategies.

Requirements

• At least five (5) years of clinical experience required.
• Leadership experience in health insurance, provider organization, or closely related experience strongly preferred.
• Doctor of Medicine (MD or DO) with an unrestricted license to practice medicine in any of the four states (MT, ID, WA, OR), or be willing to apply for state licensure in one of these four states.
• Board certification recognized by American Board of Medical Specialties (ABMS) is preferred.
• Comprehensive knowledge of business principles and techniques of administration, organization, and management.
• Excellent understanding of all areas of medical conditions, treatment, and care.
• Demonstrated skills with Microsoft Word, PowerPoint, and Excel.

Nice-to-haves

• Significant senior management policy and decision-making experience, including developing and implementing management best practices preferred.

Benefits

• Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve.
• We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to.