Vacancy expired!
DescriptionHumana Healthy Horizons is seeking a Medical Director to help develop and execute on national strategic initiatives to provide care to women. This role will work directly with established programs such as Mom's First, including pre-and postpartum periods, and develop initiatives to address women's medical and behavioral needs for adolescents, post-menopausal women and elderly women. This role requires strong collaboration with medical directors and case managers in each market and reports to the Vice President and CMO Medicaid.ResponsibilitiesMedical Directors actively use their medical background, experience, and judgement to make determinations on requested services and appropriate level of care. This role requires a strong scientific and clinical foundation of knowledge as well as a solid understanding of how organization capabilities interrelate across department(s).The primary roles and responsibilities includes:Develop and drive initiatives to address women's medical and behavioral needs for adolescents, post-menopausal women and elderly women.
Collaborate with others across the National and market clinical leadership teams to improve health outcomes, reduce health and healthcare disparities and improve health equity.
Provide medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals
Conduct clinical case reviews of the care received by members in Medicaid markets, member population, and/or condition type
May participates in discussions with external physicians to gather additional clinical information or discuss determinations
Required Qualifications:Unencumbered license to practice medicine in a state where Healthy Horizons has a contract for Medicaid (MD or DO degree)
Board Certification in a field dedicated to women's health (e.g. OB/GYN)
5+ years of clinical patient care experience
No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements.
Excellent communication skills
Experience with Medicaid recipients
Ability to work independently
Ability to develop outcomes metrics
Travel 10-20%
Reports to the Vice President and CMO of Medicaid#physiciancareersScheduled Weekly Hours32
