As a Senior Medical Director, you'll play a pivotal role in providing clinical leadership within our Health Plans division, focusing on one or more plans. Your primary responsibilities include overseeing utilization, case management, and ensuring quality outcomes. Collaborating closely with our Chief Medical Director, Medical Director(s), and Clinical Care Services (CCS) teams, you'll help establish, implement, and evaluate the effectiveness of clinical programs to support our members and achieve departmental goals. Additionally, you'll provide support to CCS nurses, Government Services nurses, Pharmacy staff, as well as Population Health and Quality Improvement Teams. External interactions will involve engaging with network physicians, vended program clinical leaders, and government program leaders to enhance the quality of clinical outcomes, cost efficiency, and overall patient/member experience with the Health Plan and Health Systems we contract with.
Key Responsibilities
Provide clinical leadership aligned with Health Plans' objectives.
Monitor utilization, case management, and quality outcomes.
Collaborate with leadership and teams to establish, implement, and evaluate clinical programs.
Support CCS nurses, Government Services nurses, Pharmacy staff, and other relevant teams.
Engage externally with network physicians, program leaders, and government representatives to enhance clinical outcomes and patient/member experience.
Minimum Requirements
Active state licensure and board certification.
Master's level degree.
Five or more years of related experience.
Preferred Qualifications
Experience with Medicaid, including long-term services and support.
Degree in Medical Management, Business Administration, or Public Health.
We're committed to providing comprehensive health insurance coverage through a range of products tailored to meet the diverse needs of our members. With over 30 years of experience in the insurance industry and two decades serving Medicaid populations, we offer innovative programs designed to support members with chronic illnesses, personalized wellness initiatives, and integrated clinical and behavioral health services. Our inclusive and supportive culture fosters community involvement and encourages personal development and growth opportunities for all team members.
Diversity And Inclusion
We believe that diversity is our strength, and we're dedicated to creating an inclusive workplace where every team member feels valued and respected. Through our Diversity and Inclusion strategy, we're focused on building a workforce that reflects the communities we serve, fostering an environment of mutual respect and belonging for all.
Benefits
As one of Virginia's largest employers, Offers a range of benefits to support our employees, including:
Medical, Dental, and Vision Insurance
Paid Annual Leave and Sick Leave
Flexible Spending Accounts
Retirement funds with matching contribution
Supplemental insurance policies
Work Perks program, including discounts on entertainment and travel
Opportunities for career advancement within the organization
Join us and be part of a team dedicated to improving the health and well-being of our members while fostering a culture of inclusivity and growth.
Employment Type: Full-Time
Seniority level
Director
Employment type
Full-time
Job function
Health Care Provider
Industries
Human Resources Services
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