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Medical Director, Medicaid Florida
4 months ago
Work Shift
First (Days) (United States of America) Sentara Health is seeking to hire a qualified individual to join our team as a
Medical Director, Medicare.
Position Status : Full-time. Possible opportunity for flexible work schedule (Hybrid).
Position Summary : Responsible for providing clinical leadership within Sentara Health Plans, aligned to one or more plans. Accountable for monitoring utilization, case management and quality outcomes. The Medical Director collaborates with the Sentara Health Plans Chief Medical Director, Senior Medical Director(s) and Clinical Care Services (CCS) teams to establish, implement, and evaluate effectiveness of clinical programs to support members and meet the department goals. Medical Director activities further include support of the CCS nurses, Government services nurses, Pharmacy staff, Population Health and Quality Improvement Teams. Lastly, Medical Directors interact externally with network physicians, vended program clinical leaders, and government program leaders as required to improve the quality of clinical outcomes, cost efficiency and patient/member experience with the Health Plan and Health Systems with which we contract.
Licensed in the state of health plan coverage and board certification
Medicaid, including long term services and support, and/or Medicare, including D-SNP
Degree in Medical Management, Business Administration or Public Health
Sentara Health Plans is the health insurance division of Sentara Health that provides health insurance coverage through a full suite of commercial products including consumer-driven, employee-owned and employer-sponsored plans, individual and family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees. With more than 30 years' experience in the insurance business and 20 years' experience serving Medicaid populations, we offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services - all to help our members improve their health. Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.
Diversity and Inclusion at Sentara
Our vision is that everyone brings the strengths that come with diversity to work with them every day. When we are achieving our vision, we have team members that feel they belong and can be their authentic selves, and our workforce is reflective of the communities we serve.
We are realizing this vision through our Diversity and Inclusion strategy, which has three pillars: A diverse and talented workforce, an inclusive and supportive workplace, and outreach and engagement with our community. Our strategies focus on both structural inclusion , which looks at our organizational structures, processes, and practices; as well as behavioral inclusion , which evaluates our mindsets, skillsets, and relationships. As the third-largest employer in Virginia, Sentara Health was named by Forbes Magazine as one of America's best large employers. Medical, Dental, and Vision Insurance
Flexible Spending Accounts
Retirement funds with matching contribution
Supplemental insurance policies, including legal, Life Insurance and AD&D among others
Sentara employees strive to make our communities healthier places to live. We're setting the standard for medical excellence within avibrant, creative, and highly productive workplace. Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve
Talroo - Health Plan
Managed Care, Health Plan, Healthcare, Medical Director
Please Note: The Covid Vaccination(s) and yearly Flu Vaccination are required for employment.
Note: Sentara Healthcare offers employees comprehensive health care and retirement benefits designed with you and your family's well-beingin mind. You have a variety of options for medical, dental and vision insurance, life insurance, disability, and voluntary benefits as well as Paid Time Off in the form of sick time, vacation time and paid parental leave. The Medical Director is responsible for providing clinical leadership within Sentara Health Plans, aligned to one or more plans. Accountable for monitoring utilization, case management and quality outcomes. The Medical Director collaborates with the Sentara Health Plans Chief Medical Director, Senior Medical Director(s) and Clinical Care Services (CCS) teams to establish, implement, and evaluate effectiveness of clinical programs to support members and meet the department goals. Medical Director activities further include support of the CCS nurses, Government services nurses, Pharmacy staff, Population Health and Quality Improvement Teams. Lastly, Medical Directors interact externally with network physicians, vended program clinical leaders, and government program leaders as required to improve the quality of clinical outcomes, cost efficiency and patient/member experience with the Health Plan and Health Systems with which we contract.
Licensed in the state of health plan coverage and board certification required. Master's level degree in Medical Management, Business Administration or Public Health preferred. Medicaid, including long term services and support, and/or Medicare, including D-SNP, experience preferred Qualifications:
MD - Doctor of Medicine (Required) Medical Doctor (MD) - Certification - North Carolina, Medical Doctor (MD) - Certification - Other/National, Medical Doctor (MD) - State License - Virginia Department of Health Professionals (VADHP) Clinical Practice, Performance Improvement, Population Management, Project Management Skills
Active Learning, Active Learning, Active Listening, Communication, Complex Problem Solving, Coordination, Critical Thinking, Judgment and Decision Making, Leadership, Learning Strategies, Mathematics, Mgmt of Financial Resources, Mgmt of Material Resources, Mgmt of Staff Resources, Microsoft Excel, Microsoft Word, Monitoring, Persuasion, Project Management, Quality Control Analysis, Reading Comprehension, Science, Service Orientation, Social Perceptiveness, Speaking {+ 5 more} Sentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application.
In support of our mission "to improve health every day," this is a tobacco-free environment.
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