Medical Director
Talence Group LLC - Portland, OR

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Report to and partner with the VP of Integrated Services.
  • Monitor and guide the evidenced based delivery of health services, promote and maintain excellent relations with all customers (patience and physicians).
  • Ensure efficient operations of Integrated Services Department.
  • Provide physician leadership to staff and health care providers.
  • Provide innovative solutions that lead to high quality care, cost effectiveness and overall improved member health.
  • Serve as Chair or Co-Chair on medical advisory committees, including Utilization Management Committee, P&T Committee, Quality Management Committee and Medical Advisory Panel
  • Provide medical consultation on development and implementation of new and innovative benefit packages.
  • Determine the appropriate utilization of health care services in order to achieve high quality outcomes in the most cost effective manner.
  • Oversee the development of quality care guidelines, internal peer review procedures, evidence-based practice, integrative healthcare model and delivery system.
  • Serve in a professional and diplomatic manner as primary liaison between the Coordinated Care Organization (CCO) /Managed Care Organization (MCO) and providers regarding matters of medical policy and medical administration.
  • Oversee training of CCO/MCO staff on matters relating to medical management, guidelines, review criteria and benefit interpretations.
  • Monitor availability, appropriateness and necessity of care rendered by participating providers and out-of-network providers.
  • Requirements
    • Doctor of Medicine (MD) or Osteopathy (DO) (or the equivalent if a foreign medical graduate), licensed by the State of Oregon.
    • Board eligibility or certification, preferably in a broad specialty area.
    • 10+ years’ experience in healthcare administration in a clinical or insurance setting.
    • Demonstrated passionate for providing integrated models of mental and physical health.
    • Knowledge in the following areas:
      • Prioritized List of Covered Services, Oregon Administrative Rule and Oregon Health Plan (OHP)/Department of Medical Assistance Program (DMAP) policy.
      • Center for Medicare & Medicaid Services (CMS) guidelines and policies.
      • Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) coding.
      • CMS Risk Score methodology.
    • Ability to maintain effective professional liaison with all levels of executive and medical staff that include professional and institutional providers of care.
    • Broad knowledge of health care industry.
    • Knowledge of current credentialing standards.
    • Skills to effectively teach and train staff regarding current medical practices and internal medical policies.
    • Ability to cultivate relationships with providers in order to support activities of Provider Relations department.
    • Ability to provide effective clinical supervision to managers of Health Services and Pharmacy to enhance efficient and clinically appropriate operation of those departments.
    • Effective provision of clinical expertise to all departments as needed.
    Benefits 100% premiums paid for health, dental, and vision insurance

    401k plan with employer contribution

    4 weeks PTO

    car allowance

    Talence Group LLC - 8 months ago - save job
    About this company
    The Talence Group has developed an innovative solution called "PerfectSelection". This method has been demonstrated over and over...