Job Details: Medical Director

Company: Health Net, Inc – With the support of more than 9,500 Health Net associates, we're building secure futures for our members, and at the same time, for our company.

Description: Health Net, Inc. (NYSE: HNT) is among the nation's largest publicly traded managed health care companies. Health Net's mission is to help people be healthy, secure and comfortable.
Health Net, Inc. (NYSE: HNT) is among the nation's largest publicly traded managed health care companies. Health Net's mission is to help people be healthy, secure and comfortable. The company's POS, HMO, insured PPO, behavioral health and government contracts subsidiaries provide health benefits to more than 7 million individuals. For more information on Health Net, Inc., please visit the company's Web site at www.healthnet.com

JOB SUMMARY:
The Senior Medical Director reports to the President, Health Net of Oregon. The Senior Medical Director works actively to implement and administer medical policies, disease and medical care management programs, integrated physician services, quality assurance, appeals and grievances, and regulatory compliance programs, with medical service and delivery systems to ensure the best possible quality care for Health Net members.

ESSENTIAL DUTIES AND RESPONSIBILITIES:
* Leads execution and implementation of Plan initiatives and programs.
* Develops, directs, and supervises the activities of the Medical Directors and their support staff.
* Leads coordination of health services functions through the Medical Directors and other medical management leadership team members.
* Actively directs and coordinates medical review, including prior authorization, concurrent review and case management at on-site/telephonic facilities, participating provider groups, direct network providers and focused employers.
* Participates in business development, program development and development of care integration models to increase efficiency and effectiveness of care delivery.
* Communicates, educates, and develops partnerships with contracted providers and IPA's, and serves as the interface between the Plan and providers.
* Provides guidance and ongoing compliance with standardized Health Net, Inc. systems, policies, programs, procedures, and workflows.
* Represents Health Net and actively develops relationships with key employer groups, physician groups, individual physicians, managed care organizations, and state medical associations and societies.
* Manages medical management programs to assure that network providers deliver and Plan members receive appropriate, high quality, cost effective care.
* Supports the state regulatory relationships and participates in the state and federal medical management regulatory audits.
* Oversees the process of investigating selected cases reported as deviating from accepted quality standards and takes appropriate actions as indicated.
* Optimizes utilization of medical resources to maximize benefits for the member while supporting Health Net Plans and Health Net corporate initiatives.
* Develops network strategy with Provider Network Management and meets regularly with Provider Network Management to ensure effective execution of the strategy as indicated.
* Supports the Plan preparation of both short and long term plans, budgets based on broad corporate goals, and objectives.
* Provides input and feedback on contracting language, division of financial responsibility, claims and benefit design plans, based on the impact to medical management, provider networks, contracting, claims, sales and others as appropriate.
* Works to ensure appropriate implementation of policies and procedures to maintain compliance with accreditation and regulatory agencies.
* Supports state regulatory relationships and serves as a lead physician for state and federal medical management regulatory audits (i.e., NCQA, HEDIS, URAC) as required.
* Supports the management of staff based on standardized performance metrics and structured performance improvement programs.
* Leads or participates on quality and care management teams and committees.
REQUIREMENTS:

Education:
Graduate of an accredited medical school; Doctorate degree in Medicine.

Certification/License:
Board certification in an ABMS recognized specialty.
Unrestricted active medical license and the ability to be licensed in Oregon and Washington.

Experience:
* Minimum five years increasingly responsible assignments, including medical management administration and clinical practice experience.
* Prior experience as a Plan medical director or in management of a private practice group.
* Demonstrated success in the management of health care costs, medical trends, and experience in utilization.

Knowledge, Skills & Abilities:
* Familiarity with the Oregon and/or Washington Healthcare market.
* Demonstrated excellent interpersonal skills.
* Demonstrated executive and organizational leadership skills.
* A team leader able to lead and manage in a matrix organization with abilities in conflict resolution.
* Strong understanding of issues and challenges that face health plans, providers, employers, staff, and members.
* Ability to effectively interface with all functions and at all levels within the organization.
* Working knowledge of relevant accrediting organizations (such as NCQA), along with federal and state regulations and requirements.
* Excellent oral and written communication skills as well as presentation skills.
* Demonstrated strong analytical and problem solving skills.
* Bias towards action and drives to results.
* Creative operations ability to assist in the development of new programs and effectively implement those programs.
* Ability to set priorities and achieve objectives.
* Financial skills including budgeting and monitoring of data.
* Ability to operate PC based software programs including proficiency in Word, Excel, PowerPoint, Access and Project.
* Ability and willingness to travel.

OR
Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.

For immediate consideration, visit: www.careersathealthnet.com, locate this position by Job Number 08001952, scroll down, click on job title and apply online.

Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening. Health Net and its subsidiaries are an Equal opportunity/Affirmative Action Employer M/F/V/D.
For immediate consideration, click 'Apply to Job' to locate this position by Job Number 08001952, scroll down, click on job title and apply online.

Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening. Health Net and its subsidiaries are an Equal opportunity/Affirmative Action Employer M/F/V/D.

Posting Date: Sep 9 08