Medical Director

Responsible for the development, maintenance, oversight and implementation of medical management policies, procedures and guidelines applicable to the facilitation of the provision of quality, cost effective care for the enrolled patient population of Samaritan Health Plans and IHN-CCO, including a focus on delegated Medical Management vendors. Working with the Chief Medical Officer, oversees clinical and behavioral health care for products and services and oversees the health care needs of the membership. Is accountable for, and provides professional leadership and direction to the utilization / cost management and clinical quality management functions. Works collaboratively with other plan functions that interface with Medical Management. Assists in short and long range program planning, quality improvement and external relationships. Works within Medical Management and with other departments for support, assistance and direction in overall medical management effectiveness.

• DEPARTMENT DESCRIPTION

Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures : InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services’ self-funded employee health benefit plan. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services’ mission of Building Healthier Communities Together.

• EXPERIENCE / EDUCATION / QUALIFICATIONS

Current unencumbered Oregon MD or DO licensure required.

• Successful completion of a residency program in a primary care specialty with Board Certification required.
• Three (3) years of clinical practice experience required.
• One (1) year of leadership experience in a managed care system required.
• Experience with community or migrant health centers preferred.
• Experience in the development and implementation of effective health care policy, particularly in the areas of quality monitoring, medical appropriateness, and utilization of health care services preferred.
• Additional business related degrees or training strongly preferred.
• KNOWLEDGE / SKILLS / ABILITIES

Effective written and verbal communication skills to perform group presentations, tactfully discuss issues, and listen to and understand concepts, rules and procedures. Ability to work with all levels within the organization, facilitate communication, and effectively document related activities.

• Ability to identify complex problems, review related information, employ creativity and alternative thinking to develop and evaluate options and implement solutions.
• PHYSICAL DEMANDS

Rarely

1 - 10% of the time)

Occasionally

11 - 33% of the time)

Frequently

34 - 66% of the time)

Continually

67 – 100% of the time)

CLIMB - STAIRS

LIFT (Floor to Waist : 0"-36") 0 - 20 Lbs

LIFT (Knee to chest : 24"-54") 0 – 20 Lbs

LIFT (Waist to Eye : up to 54") 0 - 20 Lbs

CARRY 1-handed, 0 - 20 pounds

BEND FORWARD at waist

KNEEL (on knees)

STAND

WALK – LEVEL SURFACE

ROTATE TRUNK Standing

REACH - Upward

PUSH (0 - 20 pounds force)

PULL (0 - 20 pounds force)

CARRY 2-handed, 0 - 20 pounds

ROTATE TRUNK Sitting

REACH - Forward

MANUAL DEXTERITY Hands / wrists

FINGER DEXTERITY

PINCH Fingers

GRASP Hand / Fist

PI261223485