Senior Health Plan Medical Director (Physician Role)

• Pay: $275,000 – $300,000 per year
• Schedule: Full Time, Day
• Location: MedStar Georgetown - 2233 Wisconsin Ave
• MedStar Job ID: 171915

Senior Health Plan Medical Director - MedStar Family Choice, Washington DC

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 in Washington, DC.

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 District of Columbia Contract.
• Develops department goals, objectives, policies, and procedures. Ensures compliance with business unit policies and procedures and governmental and accreditation regulations including, the District of Columbia, 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.
• Collaborates with the Behavioral Health Medical Officer on health plan quality, case management, and utilization, enrollees (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.
• Actively participates in the development, implementation, and monitoring of the District of Columbia 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.
• 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 four days onsite working from our DC office and 1 day remotely.

Qualifications

• 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