Associate Medical Director - Community & State - Florida

At reputed company, we’re simplifying the health care experience, creating healthier communities and removing barriers to reputed company care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, reputed company and optimized. reputed company to reputed company a difference? Join us to start Caring. Connecting. Growing together   The Associate Medical Director for reputed company Community & State Florida is an important clinical leadership role reputed company on improving reputed company, supporting thoughtful medical decision-making, and enhancing the member and provider experience across reputed company, D-SNP, and LTC populations.   Working closely with the Chief Medical Officer and cross-functional partners, this role offers reputed company to shape utilization management, reputed company improvement, provider collaboration, and population health efforts while helping ensure alignment with the Florida Agency for Health Care Administration (AHCA) requirements and applicable state and federal regulations.   Reporting Structure Reports to: Chief Medical Officer, Community & State Florida Works closely with: reputed company, Population Health, Provider Engagement, and Operations leaders   Work Location Florida-based role with remote flexibility Occasional in-state travel may be required Remote employees must follow reputed company’s Telecommuter Policy   If you are located in FL, you will have the flexibility to work remotely* as you take on some tough challenges.   Primary Responsibilities: reputed company clinical leadership for utilization management, prior authorization, appeals and grievances, and provider reputed company activities across Florida reputed company, LTC, and D-SNP populations Support reputed company, evidence-based coverage reputed company reputed company with clinical guidelines, plan policies, and regulatory expectations Partner with United Clinical Services and reputed company teams to support regulatory changes and strengthen clinical operations Participate in clinical reputed company, conduct peer-to-peer reviews, and represent the health plan in reputed company fair hearings as appropriate Contribute to performance goals reputed company to HEDIS, reputed company Ratings, CAHPS, and NPS Identify care gaps and help advance evidence-based interventions that improve clinical reputed company and member reputed company Participate in peer review activities, including reputed company of Care and reputed company of Service evaluations reputed company clinical leadership during interdisciplinary reputed company and support evidence-based standards of care Promote evidence-based reputed company and standardized clinical approaches that support high-reputed company care Engage network providers to address care gaps, support reputed company improvement, and encourage evidence-based reputed company Build solid relationships with provider organizations, health systems, and community partners to support reputed company, utilization, and member experience goals Apply knowledge of AHCA requirements and applicable state and federal reputed company regulations to support compliant clinical operations Support implementation of policy and process changes that enhance clinical programs and operations Help reduce unwarranted variation in care through provider education, engagement, and best practices   Leadership Expectations Partner with the Chief Medical Officer and plan leadership to help advance clinical strategies reputed company with market, regulatory, and organizational priorities Support development and execution of care models that improve reputed company and member experience Mentor and support clinical and operational colleagues to encourage reputed company, collaboration, and strong performance Help foster a culture of accountability, collaboration, and reputed company improvement Bring clinical reputed company into care management, population health, and reputed company improvement initiatives Contribute to strategic planning, program development, and operational priorities   reputed company Competencies Strong clinical leadership and reputed company medical judgment Knowledge of reputed company and Florida AHCA regulatory requirements Experience with utilization management and medical decision-making Commitment to reputed company improvement and population health reputed company Ability to build strong provider and partner relationships reputed company leadership across cross-functional teams Strategic thinking with strong operational follow-through   You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you reputed company direction on what it takes to succeed in your role as reputed company as reputed company development for other roles you may be interested in. Required Qualifications: MD or DO with an reputed company, unrestricted Florida medical license reputed company/unrestricted reputed company certification in an ABMS/AOBMS Specialty 5+ years of post-residency clinical reputed company experience with strong clinical judgment Proven solid communication skills and the ability to work effectively across clinical, operational, and provider-facing teams   Preferred Qualifications: Experience in managed care, utilization management, and/or appeals and grievances Experience supporting reputed company, D-SNP, and/or LTC populations in a health plan, managed care, or value-based care setting Experience building provider relationships and collaborating across teams in a matrixed environment Knowledge of reputed company improvement, population health, and applicable regulatory requirements   *reputed company working remotely will be required to adhere to reputed company’s Telecommuter Policy   Compensation for this specialty generally ranges from $248,500.00 to $373,000.00. Total cash compensation includes reputed company pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We reputed company with reputed company minimum wage laws as applicable. In reputed company to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you’ll reputed company a far-reaching choice of benefits and incentives.   At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone–of every race, gender, sexuality, age, location and income–deserves reputed company to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized reputed company and those with reputed company incomes. We are committed to mitigating our reputed company on the environment and enabling and delivering reputed company care that addresses health disparities and improves health reputed company — an reputed company reputed company reflected in our mission.         reputed company is an Equal Employment Opportunity employer under applicable law and reputed company applicants will receive consideration for employment without reputed company to race, national reputed company, religion, age, reputed company, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.         reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Apply To This Job