Medical Director - Medicare- Richmond/Virginia Beach, VA and Remote!

Company: Sentara Healthcare Inc
Location: Virginia Beach
Posted on: March 19, 2023

Job Description:

Optima Health is recruiting a Medical Director with Medicare experience!This is afull time position with dayshift hours and great benefits!Work Location:

• Preference is for the hire to reside in Virginia, near Richmond or Virginia Beach area, with the ability to travel in person to Virginia Beach or Richmond occasionally as needed.
• Consideration will be given to a qualified candidate as a remote worker in one of these states only: VA, NC, AL, DE, FL, GA, ID, IN, KS, LA, ME, MD, MN, NE, NV, NH, ND, OH, PA, SC, SD, TN, TX, UT, WA, WV, WI, WY!Job responsibilities:
  • 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.Job requirements:
    • Required: MD - Doctor of Medicine
    • Board certification required
    • Active VA Medical License to practice
    • Master's level degree in Healthcare Administration Business Administration or Public Health preferred
    • Medicare, including D-SNP, experience preferred
    • 5+ years experience in a Medicare Advantage or Medicaid Plan with D-SNP and/or C-SNP experience a plus.
    • Experience with NCQA a plus.
    • Clinical Practice- 5 years
    • Performance Improvement- Previous Experience
    • Population Management- Previous Experience
    • Project Management- Previous Experience
    • Progressive leadership experience preferredBenefits: Sentara offers an attractive array of full-time benefits to include Medical, Dental, Vision, Paid Time Off, Sick, Tuition Reimbursement, a 401k/403B, 401a, Performance Plus Bonus, Career Advancement Opportunities, Work Perks, and more.Sentara Healthcare offers employees comprehensive health care and retirement benefits designed with you and your family's well-beingin mind. Ourbenefits packages are designed to change with you by meeting yourneeds now and anticipating what comes next. 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. Team Members have the opportunity to earn an annual flat amount Bonus payment if established system and employee eligibility criteria is met.For applicants within Washington State, the following hiring range will be applied: $258,782.16to $427,015.68/annually. This position is also eligible for a 15% Management Bonus.Headquartered in Virginia Beach, VA, Sentara Health Plans is the health insurance division of Sentara Healthcare, offering health plans through its subsidiaries, Optima Health and Virginia Premier. Collectively, Optima Health and Virginia Premier provide health insurance coverage to over900,000 members 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. Wherever we serve our members, Optima Health stands out through our passion for health and service excellence.Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.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 and use the following as your Keyword Search: JR-23643.#Indeed#LI-PM1MonsterTalroo - LeadershipMedical Director, Medicare, MD, Doctor, Board Certified, Healthcare, Health Plan, D-SNP, C-SNP, Doctor of Medicine, Virginia Beach, Richmond, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington (state), West Virginia, Wisconsin, WyomingThe 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.
      
      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
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        • Doctor of Medicine
          • Project Management Previous Experience
          • Population Management Previous Experience
          • Performance Improvement Previous Experience
          • Clinical Practice 5 years
            • Troubleshooting
            • Time Management
            • Technology/Computer
            • Systems Evaluation
            • Systems Analysis
            • Speaking
            • Social Perceptiveness
            • Service Orientation
            • Science
            • Monitoring
            • Microsoft Word
            • Microsoft Excel
            • Mgmt of Staff Resources
            • Mgmt of Material Resources
            • Mgmt of Financial Resources
            • Mathematics
            • Learning Strategies
            • Reading Comprehension
            • Leadership
            • Quality Control Analysis
            • Judgment and Decision Making
            • Critical Thinking
            • Project Management
            • Coordination
            • Persuasion
            • Complex Problem Solving
            • Communication
            • Active Listening
            • Active Learning
            • Writing

Keywords: Sentara Healthcare Inc, Virginia Beach , Medical Director - Medicare- Richmond/Virginia Beach, VA and Remote!, Executive , Virginia Beach, Virginia