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News & Press: Physician Message Board

FamilyCare, Inc seeking Medical Director

Friday, May 16, 2014   (0 Comments)
Posted by: FamilyCare, Inc.
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FamilyCare, Inc. is a Medicaid and Medicare managed healthcare organization based in Portland, Oregon. We embody our mission statement--Creating Healthy Individuals through Innovative Systems--in everything we do. Our dedication to customer service has earned us an outstanding reputation in the Northwest healthcare industry.

We believe that in order to build on our nearly 30 year tradition of success, we must continue to seek out and attract talented individuals. We offer a challenging work environment with opportunities for growth and development. Communication is encouraged, and excellence is rewarded. FamilyCare offers a generous and highly competitive benefits package which includes health, dental, and vision insurance as well as a 401k plan with employer contribution, and liberal annual PTO.

FamilyCare, Inc. is seeking an innovative and forward thinking Medical Director who will ensure the evidence based validity and consistency of all clinical activities and projects conducted by FamilyCare to ensure cost-effective and quality utilization of medical services, and improve the health of FamilyCare members and the community in an overall effort to realize FamilyCare's Mission to Create Healthy Individuals through Innovative Systems.

Requirements/Qualifications:
• Doctor of Medicine or Osteopathy (or the equivalent if a foreign medical graduate), licensed by the State of Oregon.
• Board eligibility or certification, preferably in a broad specialty area.
• Ten years’ experience in healthcare administration in a clinical or insurance setting.
• Work in partnership with VP of Integrated Services to monitor and guide the Evidenced Based delivery of Health Services, promote and maintain excellent relations with all customers, and ensure efficient operations of Integrated Services Department.
• Provide physician leadership to staff and health care providers.
• Responsible for warranting and controlling the appropriate utilization of health care services in order to achieve high quality outcomes in the most cost effective manner.
• Oversee the development of quality care guidelines, internal peer review procedures, evidence-based practice, integrative healthcare model and delivery system.
• Serve in a professional and diplomatic manner as primary liaison between the Coordinated Care Organization (CCO) /Managed Care Organization (MCO) and providers regarding matters of medical policy and medical administration.
• Oversee training of CCO/MCO staff on matters relating to medical management, guidelines, review criteria and benefit interpretations.
• Serve as Chair or Co-Chair on medical advisory committees, including Utilization Management Committee, P&T Committee, Quality Management Committee and Medical Advisory Panel
• Provide medical consultation on development and implementation of new and innovative benefit packages.
• Monitor availability, appropriateness and necessity of care rendered by participating providers and out-of-network providers.
• Detailed knowledge of Prioritized List of Covered Services, Oregon Administrative Rule and Oregon Health Plan (OHP)/Department of Medical Assistance Program (DMAP) policy.
• Detailed knowledge of Center for Medicare & Medicaid Services (CMS) guidelines and policies.
• Detailed knowledge of Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) coding.
• Detailed knowledge of CMS Risk Score methodology.
• Ability to maintain effective professional liaison with all levels of executive and medical staff that include professional and institutional providers of care.
• Broad knowledge of health care industry.
• Knowledge of current credentialing standards.
• Lead by example and model professional behavior to staff.
• Use critical thinking skills to effectively analyze utilization data.
• Ability to formulate and communicate acceptable medical policies and to enforce those policies through appropriate action.
• Ability to effectively function as a member of a team.
• Ability to practice medicine in clinical setting or general practitioner setting.
• Knowledge of current medical practice issues and excellent clinical judgment.
• Ability to professionally represent FamilyCare in the community, with providers, and with outside agencies.
• Skills to effectively teach and train staff regarding current medical practices and internal medical policies.
• Ability to cultivate relationships with providers in order to support activities of Provider Relations department.
• Ability to provide effective clinical supervision to managers of Health Services and Pharmacy to enhance efficient and clinically appropriate operation of those departments.
• Effective provision of clinical expertise to all departments as needed.

 
FamilyCare is proud to afford equal employment opportunities to all qualified individuals, without regard to their race, color, ancestry, religion, sex, sexual orientation, national origin, age, physical or mental disability, citizenship status, veteran status, gender identity or expression, or any other characteristic or status that is protected by federal, state or local law. To ensure that we continue to hire competent, ethical, and trustworthy individuals, all candidates must successfully complete a thorough background investigation and drug screen prior to receiving any offer of employment from FamilyCare.

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