Medicare Medical Director (MD)

OUR COMMITMENT TO A HUMAN HIRING PROCESS

We believe every candidate deserves thoughtful consideration. That’s why we do not use AI or automated systems to review applications. Every application is reviewed by a real human member of our team. Because we take the time to give each submission the attention it deserves, our review process may take a little longer — and we genuinely appreciate your patience as we work through applications carefully and respectfully. 

SERVICE AREA PREFERENCE

While we encourage all interested applicants to apply, we do give priority to those who live in, or near, our service counties: Santa Cruz, Monterey, Merced, San Benito, and Mariposa. Our mission of accessible, quality health care guided by local innovation leads everything we do, and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment. 

*This is a hybrid position with the expectation to work in our service area(s) 2-3 days per month. 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 telecomm