What are the responsibilities and job description for the Medical Director position at PacificSource?
PacificSource Medical Director
Make a Difference in the Lives of Our Members
We are seeking a dedicated Medical Director to help our members access quality, affordable care. As a Medical Director at PacificSource, you will play a critical role in shaping our clinical strategies and ensuring that our members receive the best possible healthcare.
Key Responsibilities:
- Leadership: Collaborate with stakeholders across the organization to drive clinical and business strategies focused on improving clinical performance, member experience, trend management, and quality.
- Clinical Determinations: Review and make clinical determinations on coverage for pre- or post-service requests in accordance with evidence-based guidelines, CMS coverage guidelines, and internal PacificSource policies.
- Regulatory Compliance: Develop strategy and engage with regulatory entities to fulfill obligations and execute on contractual commitments associated with the line of business.
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.
About Us:
PacificSource values diversity and inclusion in the workplace and strives to create a work environment where individual differences are appreciated, respected, and utilized to their fullest potential.
SUCCESS PROFILE:
The ideal candidate will possess excellent leadership skills, a strong understanding of clinical and business principles, and the ability to navigate complex regulatory environments. If you are passionate about delivering high-quality healthcare and making a difference in the lives of our members, we encourage you to apply for this exciting opportunity.
