Medical Director - (US-VA-Falls Church - 22047)

Compensation: $100K - $100K / Year
Minimum Education: Bachelors
Job Type: Full Time
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The position will be primarily located in the Maryland office (Linthicum MD) but will also be in the Falls Church VA office occasionally.

JOB SUMMARY: Oversees all medical care for AMERIGROUP products and services. Oversees the health care needs of the membership and serves as the principal medical manager and policy advisor to the company and health plan CEO or COO. Is accountable for and provides professional leadership and direction to the utilization/cost management and clinical quality management functions. Works collaboratively with other plan functions that interface with medical management such as provider relations, member services, benefits and claims management, etc. Assists in short and long range program planning, total quality management (quality improvement) and external relationships. Works with Corporate Health and Medical Affairs for support, assistance and direction in overall medical management effectiveness.

PRIMARY RESPONSIBILITIES:
1. Responsible and accountable to the CEO and COO and the Board for managing health plan medical costs and assuring appropriate health care delivery for AMERIGROUP health plans, products and services. Reports organizationally to the CEO or COO of the Health Plan; has a dotted line relationship to the Corporate Chief Medical Officer.
2. Plans, organizes, and directs the professional medical services program, consisting of all primary and specialty services for in-patient, out-patient, preventive and wellness programs.
3. Designs and implements health plan medical policies, goals and objectives.
4. Provides professional leadership and direction to the functions within the Medical Management Department (Utilization/Cost Management and Clinical Quality Management).
5. Responsible for and assists with the development of budgets, staffing plans and medical loss ratio projections, assuring the adequate allocation of resources to the medical management functions.
6. Responsible and accountable for the Utilization/Cost Management Program and Clinical Quality Improvement Program. Performs annual evaluation of these programs and reports findings to the plan CEO, the Quality Management Committee and to Corporate Medical Affairs. Develops annual Utilization/Cost Management and Clinical Quality Improvement work plans based on the annual program evaluation and feedback from peer review committees, QA committee, Corporate Medical Affairs, the CEO and the Board.
7. Assists the CEO with activities to promote positive community relations.

Education and Experience:
Education
Required:
* Masters in Public Health, MBA or MA preferred.
* Continuing education to remain current in medical and management areas.
* Any equivalent combination of education and experience.

Years and Type of Experience
Required:
* Five years of clinical experience in the practice of medicine, two of which have been in medical and/or health administration.
* Three to five years of management and /or clinical
experience in a managed care environment.

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