This position is responsible for leading a multidisciplinary, matrixed team in supporting both internal staff, as well as external network and other partners, in implementing effective care management, quality, and other clinical practice improvement initiatives as assigned, in support of the Quadruple Aim. Direct support may be focused on Medicaid or Medicare lines of business in a Coordinated Care Organization (CCO) environment.

Work includes four key areas:

• Best practices and network support with focus on integration (physical health, behavioral health, oral health, social health)
• Data support and translation with focus on quality improvement
• Population health framework including strong equity focused approach and resource stewardship for vulnerable populations (including value-based payments)
• Regional relationships and collaboration in a CCO environment

This position may be assigned to lead medical management, clinical informatics, behavioral health, and/or population health initiatives for the organization including clinical quality in the provider network.

• In partnership with the CCO Medical Director, Senior Medical Director and/or other Medical Directors, and teams, develop, implement, and manage clinical programs to address member needs.
• Implement, direct, and oversee utilization, case, disease, and/or quality management programs.
• Develop and implement programs for supporting participating physicians in optimizing quality management and utilization management.
• Represent the health plan in applicable activities including medical and other professional organizations; participate in activities that enhance CareOregon's image within the community. Serve as a representative and medical spokesperson for the plan in support of CCOs, Medicare, contract negotiations and/or other provider expansion activities.
• Provide medical support for Care Management activities.
• Provide oversight of benefit determinations and appeals for medical and pharmacy as assigned by CCO Medical Director, Senior Medical Director or CMO.
• May partner with CCO leadership team to develop, implement, direct, and oversee programs that provide clinical strategy and interventions to CCO clinical systems.
• May plan and participate in CCO Clinical Advisory Panel (CAP) as an informal leader or member, depending on CCO/regional needs.
• Support and implement programs for network providers to share best clinical practice using of population / panel management and performance data on clinical quality and utilization.

• Perform work in alignment with the organization's mission, vision and values.
• Support the organization's commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
• Strive to meet annual business goals in support of the organization's strategic goals.
• Adhere to the organization's policies, procedures and other relevant compliance needs.
• Perform other duties as needed.

Experience and/or Education

Required

• Board-certified medical doctor or doctor of osteopathy in one of the primary care specialties, including obstetrics/gynecology (Internal Medicine, Family Practice or Pediatrics preferred)
• Licensed physician (MD or DO) in the State of Oregon
• Leadership experience in a managed care organization or practice setting, including, or following strong clinical practice activity

Preferred

• Administrative graduate degree, certificate of educational achievement in medical administration, or equivalent
• Experience working with a managed care organization

Knowledge

• Medical policy knowledge and skills as related to quality, case and disease management, credentialing activities and utilization management
• Clinical knowledge of the management of diverse medical problems, including impact of social concerns
• Understanding of health equity and ways social inequities impact health
• Basic knowledge of applicable regulatory and contractual requirements for Medicaid, Medicare, and commercial insurance
• Understanding of managed care operations
• Familiarity with guideline development, outcomes management, population health improvement, disease management and cost effectiveness and cost analysis studies
• Awareness of physician/provider payment issues, physician practice models and total quality and continuous quality improvement concepts

Skills and Abilities

• Excellent communication and collaboration skills for work with network providers and internal employees; ability to effectively express ideas and gain acceptance
• Ability to implement new and improved approaches to improvement of care and service quality, and to Care Management activities performed by CareOregon
• Ability to implement clinical and wellness programs to address the needs of high-risk members
• Ability to create excitement and bring individuals and teams together into a cohesive unit
• Ability to lead and/or work effectively as part of a cross-functional, matrixed team and foster an environment where change is embraced and supported
• Ability to deal with issues and problems systemically
• Ability to plan, set priorities, delegate effectively and utilize time efficiently
• Experience applying innovative and creative approaches to improve health care delivery
• Skilled in quality management techniques in a large, organized managed care setting
• Commitment to improving access and quality of care to the underserved and uninsured
• Appreciation of cultural diversity and the needs of serving a diverse patient population
• High degree of diplomacy, credibility, and persuasiveness to consistently cultivate effective working relationships
• An organized, disciplined, hands-on and process-oriented leader
• Results-oriented decision-maker with the ability to balance diverse priorities
• Proactive and action oriented; ability to drive performance
• Ability to work effectively with diverse individuals and groups

• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
• Ability to hear and speak clearly for at least 3-6 hours/day

Working Conditions

Indoor/Office Community Facilities/Security Outdoor Exposure

Member/Patient Facing: No Telephonic In Person

Hazards: May include, but not limited to, physical and ergonomic hazards.

Equipment: General office equipment

Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used.

#Li-Hybrid

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment.

Veterans are strongly encouraged to apply.

We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.

Visa sponsorship is not available at this time.