Senior Health Plan Medical Director (Physician Role) - MedStar Family Choice

About the Job

Senior Health Plan Medical Director - MedStar Family Choice, Washington DC

We are looking for a physician with senior level health plan experience to join MedStar Family Choice, our Medicaid Managed Care Organization, as the Senior Health Plan Medical Director in Washington, DC.

Key Position Details

• This position serves as a key thought partner and advisor to the Executive Director on clinical matters.
• Responsible for leadership of the health plan's clinical operations with a primary focus on developing clinical strategy and execution to drive clinical outcomes.
• Directs the development, implementation, and ongoing evaluation of the plan's medical management, utilization management, pharmacy management, case management, quality management, and clinical improvement programs to comply with the District of Columbia Contract.
• Develops department goals, objectives, policies, and procedures. Ensures compliance with business unit policies and procedures and governmental and accreditation regulations including, the District of Columbia, External Quality Review Organization (EQRO) Systems Performance Review Standards, Annual Evaluation of Drug Use Management Programs, and the National Committee for Quality Assurance (NCQA) for Health Plans and Case Management and HEDIS Technical Specifications according to plan needs.
• Collaborates with the Behavioral Health Medical Officer on health plan quality, case management, and utilization, enrollees (members) with special health care needs to integrate medical and behavioral health services.
• Reviews all denials of care for EPSDT services and Services for enrollees with Special Heath Care Needs.
• Actively participates in the development, implementation, and monitoring of the District of Columbia Utilization Management Plan and Appraisal, the Quality Improvement Plan and Appraisal, the annual Quality Work Plan including Performance Improvement Projects, HEDIS efforts and submission, NCQA-related projects, and others are completed.
• Raises the visibility of MFC in the community and within the healthcare industry at large.
• Supports the mission, vision, and values of MedStar Health and contributes to the achievement of the goals of MedStar Health.

This is a hybrid work position that requires four days onsite working from our DC office and 1 day remotely.

Qualifications:

• MD or DO Degree
• Active Board Certification
• 5 -7 years clinical experience
• Previous experience in a Health Plan or Medicaid Managed Care Environment
• Prior supervisory and leadership experience
• Must reside in the DC/Maryland area
• DC and Maryland Licensure
• Demonstrated commitment to ongoing clinical excellence and professional development.

As a MedStar Health associate, you can expect:

• A competitive salary
• Medical, dental and vision insurance
• Paid medical licensing and malpractice insurance
• Generous paid time off
• CME leave and CME allowance
• Retirement savings plan with employer match

This position has a hiring range of

USD $275,000.00 - USD $300,000.00 /Yr.

About MedStar Health

MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C. region, while advancing the practice of medicine through education, innovation, and research. Our team of 32,000 includes physicians, nurses, residents, fellows, and many other clinical and non-clinical associates working in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest home health provider in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar Health is dedicated not only to teaching the next generation of doctors, but also to the continuing education, professional development, and personal fulfillment of our whole team. Together, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. It’s how we treat people.

MedStar Health is ranked among the “Best Places to Work” by Baltimore magazine, Baltimore Business Journal and Washington Business Journal, and ranked as Top Organization for Diversity by Modern Healthcare

MedStar Health is an Equal Opportunity (EO) Employer and assures equal opportunity for all applicants and employees. We hire people to work in different locations, and we comply with the federal, state and local laws governing each of those locations. MedStar Health entities that are federal government contractors are Equal Opportunity and Affirmative Action employers. MedStar Health makes all decisions regarding employment, including for example, hiring, transfer, promotion, compensation, benefit eligibility, discipline, and discharge, without regard to any protected status, including race, color, creed, religion, national origin, citizenship status, sex, age, disability, veteran status, marital status, sexual orientation, gender identity or expression, political affiliations, or any other characteristic protected by federal, state or local EO laws. If you receive an offer of employment, it is MedStar Health's policy to hire its employees on an at-will basis, which means you or MedStar Health may terminate this relationship at any time, for any reason.