Providence is seeking a physician leader with experience and interest in quality medical management, to serve as a medical director within Providence Health Plan (PHP) in Beaverton, Oregon. This position is responsible, in cooperation with the CMO, AVP of Medical Management and other medical directors, for planning, developing and coordinating systems of care and quality assurance activities with resultant medical management savings. PHP earned a 5-star rating in both 2014 and 2015 and has NCQA Commendable accreditation. This is an outstanding opportunity to help lead and grow a successful integrated pharmacy and medical health plan model in one of the nation's most progressive states in terms of health care innovation and reform. Enjoy outstanding quality of life in the heart of the Pacific Northwest.
Primary duties include but are not limited to:
Clinical liaison and medical expert for the PHP Pharmacy team, providing guidance for the clinical operational aspects of the Pharmacy program serving as chair the Oregon P&T committee and an active member of the PSJH System P&T Committee.
Serving on additional committees within PHP as a clinical resource and consultant
PHP medical representative to external entities and/or serve on external committees as business needs dictate.
Playing an integral role in the PHP Quality Medical Management department participating in pharmacy management, concurrent review, prior authorization, claims audit, complex case management, reduction of physician variation, and care process improvement.
Conducting provider reconsiderations and member appeal case reviews as well as peer to peer discussions with ordering providers to discuss review determinations.
Where You'll Work
Providence Health Plan offers health insurance to hundreds of thousands of members in three states. By collaborating with provider groups, Providence Health Plan delivers health care that increases access, controls costs and ensures quality. The Oregon Public Employees Benefit Board selected Providence Health Plan to administer its self-funded health plan, making the organization a leader in accessible health care.
Where You'll Live
Portland is rich in character and culture, with strong neighborhood identities and community bonds that defy its population of 2.3 million. Home of the Portland Trail Blazers, "Rip City" is ranked No. 8 in the Best Places to Live by U.S. News & World Report, based on its high quality of life and thriving job market. A foodie mecca, Portland is ideally situated between waterfalls, beaches, Mt. Hood skiing and hiking trails, forests and the Columbia River Gorge.
Who You'll Work For
Providence Health & Services (PH&S) offers a comprehensive range of health and social services at more than 20 hospitals, 400 clinics and hundreds of locally driven programs across four western states: Alaska, Montana, Oregon and Washington. With multiple Magnet and Pathway to Excellence designations, PH&S is committed to its 100-year mission of serving the poor and vulnerable by providing compassionate care to all who need its services.
Job ID Number: 11450
Facility Name: Providence Health Plan
Location Name: Portland, OR
Brand Name: Providence Health & Services
Provider Profession: Physician/Surgeon
Medical Specialty: Other
Job Setting: Hospital, Other
Type of Role: Administrative
Type of Role: Medical Director
Medical Specialty - Other: Quality Medical Management
Phone Number: (503) 203-0805
Schedule: Full Time
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