Associate Medical Director - Health Plans
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Samaritan Health Plans (SHP) is located in the mid-Willamette Valley in Corvallis, Oregon. 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. There are several lines of business which include InterCommunity Health Network (IHN) as the Medicaid CCO in Linn, Benton and Lincoln counties. Samaritan Advantage is our Medicare line of business and there are also other commercial lines.
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As the Associate Medical Director, you will assist leadership in developing and effectively implementing Clinical Services Division programs, especially focused on the Care Coordination department and their teams of Utilization Review and Care Management. The primary function will include utilization management, case management review, and prior authorization review.
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Our ideal candidate will have the following:
- - Experience with health plans, Oregon Medicaid’s prioritized list, and the Medicare population
- - Experience or familiarity with the Medicare approval process for utilization management for Medicare/Medicaid programs
- - Willingness to learn and openness to coaching
- - Oregon MD or DO license upon hire is required
- We are open to remote out of state work in any of our approved states: Alabama, Alaska, Arizona, Arkansas, Connecticut, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, or Wisconsin
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EXPERIENCE/EDUCATION/QUALIFICATIONS
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Current unencumbered Oregon MD or DO license required.
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Successful completion of a residency program in a primary care specialty (Family Medicine, Internal Medicine, Pediatrics) with Board Certification preferred. Psychiatry and OB/GYN highly considered.
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Five (5) years of clinical practice experience required. Exceptions may be made for equivalent health plan experience.
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Leadership experience in a managed care system preferred.
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Experience with community or migrant health centers preferred.
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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.
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Additional business related degrees or training strongly preferred.
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KNOWLEDGE/SKILLS/ABILITIES
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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.
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Ability to identify complex problems, review related information, employ creativity and alternative thinking to develop and evaluate options and implement solutions.
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PHYSICAL DEMANDS
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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)
SIT
CARRY 2-handed, 0 - 20 pounds
ROTATE TRUNK Sitting
REACH - Forward
MANUAL DEXTERITY Hands/wrists
FINGER DEXTERITY
PINCH Fingers
GRASP Hand/Fist
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