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Adventist Health is hiring a Health Plan Medical Director. This role provides physician leadership in the development, implementation and supervision of Care Management. Maintains responsibility for clinical decision making and quality oversight, along with peer to peer discussions as necessary. Supervises and directs the activities of various levels of assigned personnel using both professional and supervisory discretion and independent judgment.

This role is based in Roseville, CA.

Responsibilities:

Ensures proper utilization of resources for members and other contracted partners in accordance with the Benefits Administration Care Management Plan. Supports preventative care, wellness initiatives and nutritional services which support care management philosophy of whole person care. Leads with an operational focus, setting strategy, objectives and policies.

Follows all Health Insurance Portability and Accountability Act (HIPAA) compliant policies and processes adopted by the Benefits Administration, including applicable laws and regulations, Fraud Awareness and the use of organizational approved web sites. Assesses, implements and evaluates growth opportunities with new and existing employer groups.

Ensures ongoing quality improvement as it relates to the Care Management program, utilization management, supervision of the clinical pharmacist(s), pharmacy technician(s), other clinicians and support staff. Ensures care provided is medically necessary and is provided in the most cost effective manner and setting. Promotes member engagement and responsibility for their own health outcomes. Prepares department(s) budgets and recommends for approval.

Interacts with physicians and other medical staff as needed to ensure appropriate care for members. Provides supervision of clinical pharmacist(s), pharmacy technician(s) and support staff. Coordinates supervisory duties with the Care Management Manager(s) for other members of the team including nurses, behavioral health specialists, dietitians and support staff. Assumes personal responsibility for professional development. Understands and follow changes in industry standards and laws around health care.

Requirements:

Medical Degree from an accredited University: Required

Master's Degree in business administration, management or health care management: Preferred

Seven years' administrative experience within a medical group practice, hospital structure or other administrative/leadership setting, or related experience: Preferred

Five years' leadership experience: Preferred

Business development and planning experience and post-graduate clinical practice experience: Preferred

Medical Degree (MD) or (DO) and currently licensed to practice, without restriction, in the State of California: Required

Board certification in a primary specialty: Preferred
Adventist Health is a faith-based, not-for-profit integrated health care delivery system serving communities in California, Hawaii, Oregon and Washington. Our workforce of 28,700 includes more than 21,000 employees; 4,500 medical staff physicians; and 3,000 volunteers. Founded on Seventh-day Adventist health values, Adventist Health provides compassionate care in 20 hospitals, more than 275 clinics (hospital-based, rural health and physician clinics), 14 home care agencies, 6 hospice agencies and 4 joint-venture retirement centers. Physician opportunities with Adventist Health involve a variety of practice models and outstanding West Coast locations. If you prefer the busy city, the quiet country or a bit of both, check out Adventist Health.