Medical Director

This role serves as a Medical Director with responsibility for providing clinical leadership for the administration of the District of Columbia’s Medicaid, CHIP, Alliance Health Care (Alliance), and Immigrant Childrens’ Programs. The position accomplishes this by directing benefit design pertaining to clinical services; utilization management practices; ongoing clinical program design, implementation, and evaluation; and the application of continuous quality measurement and improvement practices in the delivery of preventive, acute, and chronic/long-term care services to children and adults.

Duties and Responsibilities

Participates with the Director of DHCF, the Senior Deputy Director/Medicaid Director, Senior Deputy Director for Finance, and other Supervisory Healthcare Program Managers, in the review and evaluation of the scope, content, and priorities for all District and federally funded healthcare programs and administrative responsibilities within the context of present and anticipated financial resources and assists with the management and development of and justification for the annual DHCF budget. Makes or approves selections for subordinate positions. Manages subordinate employees’ work performance and implements ways to produce and promote team building or improve business practices. Approves training requests and promotes professional development for staff. Resolves employee complaints and reviews and approves disciplinary actions. Recommends awards and bonuses where appropriate.

Advises DHCF senior staff on a broad range of clinical issues related to DHCF healthcare programs and initiatives, including value-based care, evidence-based practices, and population health. Promotes and oversees the clinical policy reforms that are data driven and improve utilization management and delivery system transformation across both Fee for Service and managed care. Develops long-range, comprehensive health services and policies designed to meet the present and future needs of the District’s publicly funded healthcare programs with the goal of improving health outcomes. Evaluates existing policies, procedures, contracts, transmittals, and regulations to formulate revisions that improve clinical efficiency and effectiveness and satisfy regulatory requirements. Collaborates and advises the Director and DHCF senior staff on policy development including the development of medical necessity criteria, patient safety and health technology assessments. Oversees and collaborates with DHCF senior staff and manages care plans on peer review and quality improvement activities; and conducts medical reviews, medical necessity, prior authorization, and individual consideration determinations. Serves as Chairperson of the DC Medicaid pharmacy and therapeutics committees and advises the Director on the maintenance of the DHCF formularies and preferred drug lists. Performs other duties as assigned.

Qualifications and Education

This position requires a qualified physician by virtue of the fact that the programs under the supervision of the incumbent will involve and demand a broad knowledge of a wide variety of medical fields and the application of medical administrative skills and abilities.

The incumbent shall possess at least five (5) years of demonstrated experience in a supervisory or managerial position in a clinical setting or a public health agency. Expert professional knowledge and experience with quality improvement, performance improvement, and clinical guidelines to develops long-range, comprehensive health services and policies designed to meet the present and future needs of the District’s publicly funded healthcare programs.

Licenses and Certifications

This position requires a qualified licensed physician who possesses a current, active, full, and unrestricted license or registration license to practice Medicine and Surgery in the District of Columbia.

Working Conditions/Environment
The work is performed in a typical office setting.

Other Significant Facts
Tour of Duty: Monday – Friday; 8:15 a.m. – 4:45 p.m.
Duration of Appointment: Medical Service – Management Supervisory Service (At Will): All positions and appointments in the Management Supervisory Service serve at the pleasure of the appointing authority and may be terminated at any time with or without cause.
Promotion Potential: No Known Promotion Potential
Pay Plan, Series and Grade: MD-0602-04
Collective Bargaining Unit: This position is not represented by a collective bargaining unit.

Residency Requirement: Applicants claiming “Residency Preference” will be required to maintain residency in the District of Columbia for a minimum of seven (7) years. Failure to do so may result in forfeiture of employment.

If the position you are applying for is in the Career, Management Supervisory, or Educational Service at an annual salary of one hundred fifty thousand dollars ($150,000) or more, you must establish residency in the District of Columbia within one hundred eighty (180) days of the effective date of the appointment and continue to maintain residency within the District of Columbia throughout the duration of the appointment.

Position Designation: This position has been designated as security sensitive therefore the incumbent of this position will be subject to enhanced suitability screening pursuant to Chapter 4 of DC Personnel Regulations, Suitability and as such, incumbents of this position shall be subject to criminal background checks, background investigations, and mandatory drug and alcohol testing, as applicable.

EEO Statement: The District of Columbia Government is an Equal Opportunity Employer. All qualified candidates will receive consideration without regard to race, color, religion, national origin, sex, age, marital status, personal appearance, sexual orientation, family responsibilities, matriculation, physical handicap, or political affiliation.