Associate Medical Director

Job Description:

• Apply medical expertise within the Physician Review team to help ensure members receive quality, cost-effective clinical care
• Support development and communication of medical policies and clinical programs
• Work with clinical staff on case management reviews
• Provide peer-to-peer consultations with providers
• Participate on clinical project teams
• Provide clinical consulting to staff on member cases and broader clinical trends
• Conduct member case reviews and peer-to-peer consultations
• Communicate with internal and external stakeholders about care management, utilization management, and quality programs
• Provide clinical input on medical policy reviews and development
• Participate on committees developing clinical intervention, utilization management, and case management programs
• Monitor industry, medical, and technology trends
• Identify and communicate opportunities to enhance outcomes and organizational reputation

Requirements:

• Licensed Physician with an MD or DO degree
• Minimum 3 years clinical experience, or equivalent combination of education and experience
• Active, unrestricted license to practice medicine in one or more states or territories of the United States
• At least one active license in Oregon, Washington, Idaho, or Utah
• Applicant must live in Oregon, Washington, Idaho, or Utah
• Board Certification required
• Qualification by training and experience to render clinical opinions about medical conditions, procedures, and treatments under review
• Experience working with hospitals, provider groups, or integrated delivery systems
• Knowledge of population health and healthcare transformation
• Strong communication, influencing, and facilitation skills
• Knowledge of health insurance industry, state and federal regulations, provider reimbursement methods, and accountable care and payment models
• Ability to apply data to health and quality outcomes
• Ability to effectively utilize systems and technology
• Ability to build relationships, demonstrate empathy, and work as part of a team
• Experience with AI tools and technologies highly desired
• Wired internet connection that is not satellite or cellular, with minimum 5 Mb upload and 10 Mb download speeds
• Personal mobile device required for MFA
• Successful background check required

Benefits:

• Competitive base pay
• Bonus opportunities
• Market-leading 401(k) with a significant company match
• Potential discretionary 401(k) contribution based on company performance, with no vesting period
• Medical, dental and vision coverage for employees and eligible family members, including mental health benefits
• Annual employer contribution to a health savings account
• Generous paid time off varying by role and tenure
• 10 company-paid holidays
• Up to 12 weeks of paid parental time off, subject to 12 months of continuous service
• Award-winning wellness programs that reward participation
• Employee Assistance Fund
• Commute and parking benefits
• Work-from-home options for most roles
• Flexible work option with required wired internet connection
• Employee resource groups
• Cambia-supported community outreach programs