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Senior Medical Director, Medicaid Virginia

3 months ago

Jacksonville, United States Sentara Full time

City/State

Tallahassee, FL

Overview

Work Shift

First (Days) (United States of America)

Sentara Health Plans is recruiting a Senior Medical Director- Medicaid

This is a remote position for a resident of one of the following states:

Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Dakota, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington (state), West Virginia, Wisconsin, Wyoming

The Senior Medical Director -Medicaid 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 Senior Medical Director collaborates with the Sentara Health Plans Chief Medical Director, 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, experience preferred

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 Senior Medical Director collaborates with the Sentara Health Plans Chief Medical Director, 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.

Minimum Requirements:

  • Licensed in the state of health plan coverage and board certification

  • Master's level degree

  • Five years or more of related experience

Preferred:

  • Medicaid, including long term services and support,

  • 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. We have made remarkable strides in these areas over the past several years and, as our world continues to evolve, we know our work is never done.

Our strategies focus on bothstructural inclusion, which looks at our organizational structures, processes, and practices; as well asbehavioral inclusion, which evaluates our mindsets, skillsets, and relationships. Together, these strategies are moving our organization forward in an environment that fosters a culture of mutual respect and belonging for all.

Sentara Benefits
As the third-largest employer in Virginia, Sentara Health was named by Forbes Magazine as one of America's best large employers. We offer a variety of amenities to our employees, including, but not limited to:

  • Medical, Dental, and Vision Insurance

  • Paid Annual Leave, Sick Leave

  • Flexible Spending Accounts

  • Retirement funds with matching contribution

  • Supplemental insurance policies, including legal, Life Insurance and AD&D among others

  • Work Perks program including discounted movie and theme park tickets among other great deals

  • Opportunities for further advancement within our organization

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. For information about our employee benefits, please visit:Benefits - Sentara (sentaracareers.com)

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

To apply, please go to www.sentaracareers.com

#Indeed

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#LI-AR1

Talroo - Health Plan

Managed Care, Health Plan, Healthcare, Medical Director

Job Summary

The Senior 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 Senior Medical Director collaborates with the Sentara Health Plans Chief Medical Director, 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, 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.

Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.gov for further information. 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.