About the Job Senior Health Plan Medical Director/Medical Officer, Baltimore, MD - MedStar Family Choice 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/Medical Officer in the Baltimore, MD region. 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 Maryland Contract. Develops department goals objectives policies and procedures.
Ensures compliance with business unit policies and procedures and governmental and accreditation regulations including Maryland 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. Actively participates in the development implementation and monitoring of Maryland 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.
Collaborates on health plan quality case management and utilization of 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. Leads and executes on innovative Managed Care disciplines to ensure optimal total cost of care management. Work collaboratively in developing various strategic medical expense approaches such as value based contracting strategy.
Develops collaborative relationships with Maryland agencies and associates, MedStar Health system leaders, academic physicians, hospitals, community physicians, and related networks. 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 three days onsite working from our Maryland office and also remotely.
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 Be a part of a nationally - recognized health system and the largest provider of health services in the DC, Maryland and Virginia region.
With our vast resources and capabilities at your disposal, you can expand your clinical expertise. Enjoy a rich career and a quality of life unique to the Mid-Atlantic region, which features a mix of urban, suburban and rural communities. MedStar Health is the largest health system in the region, with 30,000 associates, working at 10 hospitals, hundreds of ambulatory care sites – all together more than 700 access points of care, covering more than 225 zip codes in 17 counties.
We are also ranked among the “Best Places to Work” by Baltimore magazine, Baltimore Business Journal, and Washington Business Journal. MedStar Health is committed to equity for all people and communities. A proud member of the Institute for Diversity in Healthcare Management, we are committed to expanding career and leadership opportunities for ethnically, culturally, and racially diverse individuals.
We continue to build a diverse and inclusive workplace where people feel a sense of belonging and accomplishment at all levels of the organization. As a leader in healthcare, we are taking action to evolve our organization and bring unique, multidimensional perspectives together to deliver equitable care, improve the health of the communities we serve, and contribute to the advancement of the healthcare industry overall.
At MedStar Health, we believe diverse teams and perspectives make us stronger, lead to better care for our patients, and foster a supportive work experience for our associates. Our commitment to diversity is built into our SPIRIT values, where we acknowledge that teamwork and system effectiveness is built on the collective strength and cultural diversity of everyone working with open communication and mutual respect. #DOX #LI-ER1 This position has a hiring range of USD $275,000.00 - USD $300,000.00 /Yr.