Health Plan Medical Director

Rosaires Care; Washington (District of Columbia); Presencial; USD 250.000 - 350.000; Jornada completa

Descripción de la vacante

Rosaires Care in Washington, DC area seeks a Physician Leader to drive clinical strategy and operations for a Medicaid managed care plan. You will lead medical management, utilization management, pharmacy, case management and quality initiatives to deliver evidence-based care and improved outcomes.

Responsibilities include designing and implementing clinical programs, ensuring regulatory/compliance standards, and collaborating with health system leaders and community partners to achieve

Formación

• Physician leadership experience in managed care or clinical operations.
• Strong knowledge of utilization management, pharmacy-related processes, case management and quality initiatives.
• Proven ability to drive compliance, performance and cross-functional collaboration.
• Excellent communication and stakeholder management skills.

Responsabilidades

• Oversee clinical program design, implementation, and continuous improvement.
• Ensure regulatory and accreditation compliance across clinical operations.
• Collaborate with health system leaders, clinicians, and community partners to improve outcomes.
• Provide physician-level leadership to support evidence-based care and effective care management.

Conocimientos

Physician leadership

Utilization management & pharmacy

Compliance & cross-functional collab

Communication & stakeholder management

Descripción del empleo

Physician Leader (Clinical Strategy & Operations)

Lead clinical strategy and operational performance for a Medicaid managed care plan, directing key programs including medical management, utilization management, pharmacy, case management, and quality.

• Oversee clinical program design, implementation, and continuous improvement.
• Ensure regulatory and accreditation compliance across clinical operations.
• Collaborate with health system leaders, clinicians, and community partners to improve outcomes.
• Provide physician-level leadership to support evidence-based care and effective care management.

Key Qualifications/skills

• Physician leadership experience with managed care or clinical operations.
• Strong knowledge of utilization management, pharmacy-related processes, case management, and quality initiatives.
• Proven ability to drive compliance, performance, and cross-functional collaboration.
• Excellent communication and stakeholder management skills.