Medical Director - PRN

Health Services for Children with Special Needs, Inc (HSCSN is a small, Medicaid Managed Care Organization (health plan) that is contracted with the District of Columbia to administer the Child and Adolescent Supplemental Security Income Program (CASSIP). HSCSN enrollees are eligible for CASSIP if they are between 0 and 26 years and have Supplemental Security Income (SSI) or are considered SSI-eligible. HSCSN is an integrated health plan, providing both physical health and behavioral health services.

The Medical Director (for physical health) is a PRN position in the Medical Affairs Department reporting to the Chief Medical Officer and is a physician leader for HSCSN. The medical director routinely participates in activities of the Utilization Management and Care Management Departments including authorization decisions, rounds, multidisciplinary team meetings, and case consultations. The Medical Director is expected to use evidenced-based guidelines, approved clinical criteria and sound clinical judgment in making decisions impacting utilization of services by enrollees.

The Medical Director collaborates with the Chief Medical Officer, Chief Quality Officer and Quality Management staff to monitor, evaluate and improve the quality of health services being delivered to HSCSN enrollees. Working with cross-functional teams, the Medical Director will help lead Disease Management programs for HSCSN related to physical health conditions including Asthma, Diabetes, and Obesity. As a leader of HSCSN, serves as a clinical liaison with healthcare providers, community stakeholders, and government agencies on behalf of HSCSN.

Participates in the development of organization-wide strategic, medical, quality, medical and business planning and goal setting as related to physical health.

The Medical Director must be a physician licensed to practice medicine in the District of Columbia with experience in managing children with medical complexity and disabilities.

Minimum Education
Medical Doctor (M.D.) (Required)

Minimum Work Experience
5 years At least 5 years of clinical practice (following training) in a related specialty. (Required)
2 years Work experience with a managed care organization is preferred. (Preferred)

Required Skills/Knowledge
Familiarity with the Medicaid system.
Experience with the SSI eligible population.
Multidisciplinary team leadership.

Required Licenses and Certifications
Physician Must be a physician with a current license to practice without restriction in the District of Columbia 60 Days, (Required) Board Certification in Pediatrics, Internal Medicine or Family Medicine (Required)

Job Functions
Utilization Management:

• Completes second-level reviews of authorization decisions as assigned by members of the Utilization Management Department and within required timeframes.

• Participates in peer-to-peer discussions with relevant physicians as necessary and educates network providers regarding options for care.

• Assists in development of medical necessity criteria and other medical policy for HSCSN.

• Participates in Home Care Rounds, Inpatient Rounds, and other internal team rounds to discuss HSCSN enrollees.

• Assists with evaluation of utilization of services, including under and over-utilization.

Care Management:

• Serves as a medical advisor to care management staff regarding diagnoses, services, and enrollee care plans.

• Helps lead Disease Management program development, design, and implementation as part of a cross-functional team including Medical Affairs, Care Management, Utilization Management, and Quality Management.

• Participates in education of HSCSN Care Management and other staff regarding various topics relevant to the HSCSN population.

Quality Management:

• Participates in activities related to Provider Oversight, Vendor Oversight, and Network Adequacy.

• Participates in investigations of enrollee grievances as needed.

• Assists the CQO and Quality team in developing quality and performance metrics.

Coverage:

• Is available to perform his/her function during normal business hours and participates in a rotation of on-call medical directors as needed and as appropriate.

• Covers for the Chief Medical Officer during vacations and as needed.

Organizational Accountabilities
Organizational Accountabilities (Managers)
Leadership Excellence

• Demonstrates understanding of quality of service and collaborates with co-workers to ensure excellence is achieved

• Innovates through improvement of care and/or efficiency of operational processes.

• Dedicated to a standard of performance excellence and high quality

Collaboration

• Creates a safe environment that encourages brainstorming, creativity and "out-of-the-box" thinking

• Encourages a diverse group of people to communicate effectively and embrace creative thinking

• Drives the collaborative efforts of the team to achieve goals in the most effective and efficient way

• Demonstrates listening and feedback skills

Leadership Skills

• Proactively assumes responsibility and accountability for results to include management of organizational change

• Empowers staff in ensuring a culture of transparency, fairness, respect and excellence

• Strategically aligns operational and tactical objectives to drive business results.

• Encourages collaboration with team members based on trust, mutual respect, consistent visible support, and open and honest communication.

Supervisory Responsibilities
Blood Borne Pathogen Exposure
Protected Health Information Access Level
Working Environment
Physical Requirements
Travel Requirements

DC Residents Encouraged to Apply.

Hourly Rate:

Minimum: $72.12 - Maximum: $216.35