Medicaid Medical Director (Physician Administrator 3)

Ohio Department of Medicaid; Columbus (OH); On-site; USD 150,000 - 200,000; Full time

Job summary

The Ohio Department of Medicaid seeks a Physician Administrator to provide medical and clinical expertise in overseeing the transformation of health care delivery for Ohio's Medicaid population.

The selected candidate will define goals to enhance health outcomes, serve as clinical authority for Medicaid services, and lead initiatives ensuring compliance with healthcare regulations.

Requires a valid medical certificate and significant clinical oversight experience.

Qualifications

• Valid medical certificate issued by State Medical Board.
• Experience in clinical oversight is essential.

Responsibilities

• Define goals to improve health outcomes for Ohio's Medicaid population.
• Provide clinical oversight and approval for Medicaid coverage policies.
• Lead utilization management and population health initiatives.
• Ensure alignment with state and federal regulations.
• Monitor medical services delivery and cost-effectiveness.
• Supervise ODM personnel including medical directors and bureau chiefs.

Education

Certificate to practice medicine

Job description

Job Overview

The Ohio Department of Medicaid (ODM) is recruiting for a Physician Administrator with significant experience in clinical oversight to provide medical and clinical expertise and leadership to plan, coordinate, and direct all aspects of design, implementation, monitoring, and clinical evaluation of the ODM’s efforts to transform health care delivery for Ohio’s Medicaid population.

Responsibilities

• Defining ODM goals and objectives to improve health outcomes and overall healthcare quality in Ohio as detailed by the Ohio Medicaid Quality and Population Health Strategy and the associated metrics for Ohio's Medicaid population.
• Serving as clinical authority for ODM providing clinical oversight, input, and approval of coverage policies for all Medicaid services including pharmacy for eligible Ohioans in varied programs (Fee-For-Service, Managed Care, waivers).
• Providing leadership and oversight to utilization management, care coordination, and population health initiatives.
• Ensuring integration with other Department functions with alignment of policy, best clinical practice, and consumer needs using a person-centered approach, ensuring compliance with all state and federal regulations.
• Monitoring the delivery and cost-effectiveness of medical services and materials across varied provider types and care contexts and taking action to improve health system performance and patient experience.
• Supervising medical and non-medical ODM personnel to include Assistant Medicaid Medical Directors, Bureau Chiefs, supervisors, and management personnel and/or medical support personnel.

Qualifications

• Certificate to practice medicine as issued by State Medical Board pursuant to Sections 4731.14 & 4731.281 of Revised Code.