Medicare Medical Director (MD)

*This is a hybrid position with the expectation to work in our service area(s) 1-2 days per week. The Alliance service area includes Santa Cruz, Monterey, Merced, San Benito, and Mariposa counties. 

We have an opportunity to join the Alliance as the Medicare Medical Director (MD). 

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the Chief Medical Officer, this position:

• Acts as the Alliance’s Medicare Dual Eligible Special Needs Plan (D-SNP) clinical subject matter expert


• Provides specialized clinical D-SNP leadership within a variety of Health Services functional areas


• Develops and improves relationships with internal and external stakeholders, including the professional medical community, and maintains and enhances communications with similar Health Plan organizations


• Participates in all aspects of regulatory compliance related to D-SNP and Health Services functions

THE IDEAL CANDIDATE 

• Enjoys a fast-paced, demanding environment that requires critical thinking to develop and implement effective solutions in a timely manner 


• Is dedicated to caring for Medicare and/or Medicaid patients while addressing the social determinants of health


• Works with a broad and diverse group of stakeholders to problem solve and build cutting-edge programs


• Has the latitude to think broadly, make operational and strategic decisions, and oversee the implementation and continuous process improvement related to key internal and external priorities 

WHAT YOU'LL NEED TO BE SUCCESSFUL

To read the full position description, and list of requirements click here. 

• Knowledge of:
  
  
  
  • The needs of the Medicare population and/or Medicare Plan administration
  
  
  • The Medicare D-SNP program and related regulations, CMS D-SNP STARS Rating System, and managed care
  
  
  • Medical programs administration, quality improvement, and/or informatics
  
  
  • Data collection and management practices, as related to utilization and quality of medical care
  
  
  • Promoting and applying change management principles
  
  
  
  


• Ability to:
  
  
  
  • Provide clinical oversight and leadership of the Medicare D-SNP program
  
  
  • Analyze issues and think critically to ensure success in leading system change, make informed operational and strategic decisions, and oversee implementation and continuous process improvement related to key internal and external priorities
  
  
  • Audit, analyze, and assess medical records and other health care data
  
  
  • Interpret regulations, legal and contractual language, policies, and procedures
  
  
  
  


• Education and Experience:
  
  
  
  • Doctor of Medicine, current license to practice medicine issued by the State of California, Board certification in a specialty recognized by the American Board of Medical Specialties, and a minimum of three years of experience as an attending physician with the Medicare population or three years of experience as an attending physician which included a minimum of two years of Medicare Plan administration experience; or an equivalent combination of education and experience may be qualifying
  
  
  
  

OTHER INFORMATION

• We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.


• While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.


• In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.

The full compensation range for this position is listed by location below. 

The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).

Typical areas in Zone 1: Bay Area, Sacramento, Los Angeles area, San Diego area

Typical areas in Zone 2: Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka area

OUR BENEFITS

• Medical, Dental and Vision Plans


• Ample Paid Time Off


• 12 Paid Holidays per year


• 401(a) Retirement Plan


• 457 Deferred Compensation Plan


• Robust Health and Wellness Program


• Onsite EV Charging Stations


• And many more

ABOUT US

We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us. 

The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer

Join us at Central California Alliance for Health (the Alliance) is an award-winning regional Medi-Cal managed care plan that provides health insurance for children, adults, seniors and people with disabilities in Mariposa, Merced, San Benito and Santa Cruz counties. We currently serve more than 418,000 members. To learn more about us, take a look at our Fact Sheet.

At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.