Medicaid Medical Director
Apply NowCompany: State of Utah
Location: Salt Lake City, UT 84150
Description:
Salary: $96.90 - $159.53 Hourly
Location : Salt Lake County, UT
Job Type: Full Time
Job Number: 43819
Agency: 250 Health & Human Services
Unit: 3100 DHHS DIH Directors Office
Opening Date: 01/14/2025
Closing Date: Continuous
FLSA: Exempt
Recruiter:
# of Openings: 1
Background Check: You must successfully pass a criminal history check.
Career Mobility: This is not a career mobility assignment
Location: Cannon Health Building288 North 1460 WestSalt Lake City UT 84116 The Utah Department of Health and Human Services, Cannon Health Building is proud to be a tobacco free campus.
Schedule Code: AR - Employees who make Statewide Policy - This is a career service exempt at will position.
Benefits: This position is eligible for a full benefits package. See benefits tab below for details.
Driver License Requirements: Employees hired for this recruitment will be subject to the Driver Eligibility standards found at the following link: https://adminrules.utah.gov/public/search/driver%20eligibility/Current%20Rules
EEO Statement: The State of Utah is committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. We also consider qualified applicants regardless of criminal histories, consistent with legal requirements. For accommodations, dial 711 or TTY: [redacted].
Job Description
The Medical Director for the State Medicaid Program within the Division of Integrated Healthcare is a leadership position responsible for overseeing the healthcare quality and population health efforts for members covered by Medicaid in the state of Utah. This individual will work closely with internal Medicaid staff in medical/pharmacy policy development, program design and oversight, and, at the direction of DIH director, engage with external healthcare providers, community organizations, and government agencies to ensure that members have access to high-quality, cost-effective healthcare services that promote their overall well-being and quality of life. The Medical Director will provide expertise in standards of care and quality of care to ensure that all Medicaid members receive care that meets or exceeds established guidelines. The Medical Director will report to the Division Director and have direct oversight of specific medical policy and quality efforts within the division.
Note: as of April 8, 2024, DHHS employees will be working a hybrid schedule, which includes 2 office days per week and 3 telework days.
Why work for the Utah Department of Health and Human Services? In addition to the rich the State of Utah offers, the department offers:
For more information on the Utah Department of Health and Human Services, please click here
If offered this position, your employment will be contingent upon passing a background check and review. There will be no cost to you for this check. This check will include fingerprinting, which will be available at various DHHS locations for your convenience. Fingerprinting will be completed prior to your first day of employment. You may review the policy by clicking here.
Responsibilities
Qualifications
Supplemental Information
Benefits:
The State of Utah offers eligible employees a variety of benefits including medical, dental, life and disability insurance, as well as a comprehensive leave program. Please click the following link for a detailed information page: To access a Total Compensation Calculator in Excel format click
FMLA General Notice:
(right click + open link in new tab)
(clic derecho + abrir en una pestaa nueva?)
01
Your answers to the questions on this posting must be supported by the duties, experience, andinformation listed in your profile's work and education history, not your resume. Please select "YES" to indicate you understand the validity of your claims will be based upon information contained within your application, not your resume. Unsubstantiated claims, exclusion of information, or incomplete answers may result in the disqualification of your application or of the question. Entering "see resume" will be considered an incomplete answer.
02
Please indicate how you heard about this specific job posting.
03
In applying for this position, I understand that any offer of employment would be contingent upon me successfully completing a background screening as per the Utah Department of Health and Human Services Background Screening Policy. Link to the policy can be found in the job description.
04
Do you have a Medical Degree and current licensure to practice medicine in the State of Utah?
05
Please indicate your years of experience with health plan operations.
06
Please indicate your years of experience using healthcare quality metrics (HEDIS) to inform health interventions and priorities.
07
Please indicate your years of experience with pharmacy benefit management.
08
Please indicate your years of experience with medical policy development.
Required Question
Location : Salt Lake County, UT
Job Type: Full Time
Job Number: 43819
Agency: 250 Health & Human Services
Unit: 3100 DHHS DIH Directors Office
Opening Date: 01/14/2025
Closing Date: Continuous
FLSA: Exempt
Recruiter:
# of Openings: 1
Background Check: You must successfully pass a criminal history check.
Career Mobility: This is not a career mobility assignment
Location: Cannon Health Building288 North 1460 WestSalt Lake City UT 84116 The Utah Department of Health and Human Services, Cannon Health Building is proud to be a tobacco free campus.
Schedule Code: AR - Employees who make Statewide Policy - This is a career service exempt at will position.
Benefits: This position is eligible for a full benefits package. See benefits tab below for details.
Driver License Requirements: Employees hired for this recruitment will be subject to the Driver Eligibility standards found at the following link: https://adminrules.utah.gov/public/search/driver%20eligibility/Current%20Rules
EEO Statement: The State of Utah is committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. We also consider qualified applicants regardless of criminal histories, consistent with legal requirements. For accommodations, dial 711 or TTY: [redacted].
Job Description
The Medical Director for the State Medicaid Program within the Division of Integrated Healthcare is a leadership position responsible for overseeing the healthcare quality and population health efforts for members covered by Medicaid in the state of Utah. This individual will work closely with internal Medicaid staff in medical/pharmacy policy development, program design and oversight, and, at the direction of DIH director, engage with external healthcare providers, community organizations, and government agencies to ensure that members have access to high-quality, cost-effective healthcare services that promote their overall well-being and quality of life. The Medical Director will provide expertise in standards of care and quality of care to ensure that all Medicaid members receive care that meets or exceeds established guidelines. The Medical Director will report to the Division Director and have direct oversight of specific medical policy and quality efforts within the division.
Note: as of April 8, 2024, DHHS employees will be working a hybrid schedule, which includes 2 office days per week and 3 telework days.
Why work for the Utah Department of Health and Human Services? In addition to the rich the State of Utah offers, the department offers:
- On-site fitness center, for a minimal membership fee
- UTA Eco Pass, at a discounted monthly rate
- Teleworking opportunities with a minimum 2 office days per week beginning 04/2024.
- On-site day care center at the Cannon Health Building with First Steps Day Care - contact for rates and availability, [redacted] or [redacted]
For more information on the Utah Department of Health and Human Services, please click here
If offered this position, your employment will be contingent upon passing a background check and review. There will be no cost to you for this check. This check will include fingerprinting, which will be available at various DHHS locations for your convenience. Fingerprinting will be completed prior to your first day of employment. You may review the policy by clicking here.
Responsibilities
- Develop and implement strategies to improve healthcare quality and population health for Medicaid members in Utah.
- Serve as a focal point for quality, clinical, and survey and certification policies for Utah Medicaid's healthcare delivery models.
- At the direction of DIH director, collaborate with healthcare providers and community organizations to coordinate care and promote preventative services.
- Analyze data and utilize evidence-based practices to provide recommendations on decision-making and policy development.
- Research and propose innovative approaches for improving the quality, efficiency, and appropriateness of care delivered by Medicaid and its contracted health plans. Seek out best practices and technological solutions or other enhancements.
- Lead Utah's Medical Review Committee to review Medicaid's prior authorization decisions.
- Lead and mentor a team of healthcare professionals to achieve performance goals and objectives.
- Advise leadership and partners on the impact of different healthcare delivery models on quality and health outcomes.
- At the direction of DIH director, participate in meetings and presentations to stakeholders, including the Utah Legislature and other government agencies, and community groups.
- Build and maintain effective working relationships with cross-functional leaders and teams in order to identify, explore, present and implement clinical opportunities.
- Stay up-to-date on trends and best practices in healthcare quality and population health.
- Provide expertise in best standards of care.
Qualifications
- Medical degree and current licensure to practice medicine in the state of Utah
- Demonstrated expertise in healthcare quality and population health
- Strong leadership and management skills
- Excellent communication and interpersonal skills
- Ability to analyze data and use evidence-based practices to inform decision-making
- Commitment to improving the health and well-being of Medicaid members in Utah
Supplemental Information
- Current unlimited license to practice medicine in the State of Utah (MD).
- Effective July 1, 2021, State of Utah Employees must either reside in Utah or be in the process of relocating to within 30 days of their start date.
- This position may currently be a hybrid of both in-office and remote work days. Please note, a position's eligibility for remote work is established by agency management and is subject to change at their discretion, at any time and for any reason.
- Risks which require the use of special safety precautions and/or equipment, e.g., working around operating machines, working with contagious diseases or hazardous chemicals, etc.
- Work requires physical exertion. May require the ability to stand; walk over rough surfaces; bend, crouch, stoop, stretch, reach, lift moderately heavy items (up to 50 lbs.) in a recurring manner and/or for long periods of time.
Benefits:
The State of Utah offers eligible employees a variety of benefits including medical, dental, life and disability insurance, as well as a comprehensive leave program. Please click the following link for a detailed information page: To access a Total Compensation Calculator in Excel format click
FMLA General Notice:
(right click + open link in new tab)
(clic derecho + abrir en una pestaa nueva?)
01
Your answers to the questions on this posting must be supported by the duties, experience, andinformation listed in your profile's work and education history, not your resume. Please select "YES" to indicate you understand the validity of your claims will be based upon information contained within your application, not your resume. Unsubstantiated claims, exclusion of information, or incomplete answers may result in the disqualification of your application or of the question. Entering "see resume" will be considered an incomplete answer.
- Yes
02
Please indicate how you heard about this specific job posting.
- State of Utah job site (www.governmentjobs.com/careers/utah)
- Referred by a Friend or Family
- Indeed
- Other External Job Board or Site
- Social Media (Facebook, Twitter, etc.)
- DWS job website (www.jobs.utah.gov)
- Advertisement (Digital Ad, Billboard, Print, etc.)
- Professional Network (Association, Membership, Work Colleague)
- University Network (Handshake, School Job Board, Career Center, etc.)
- Contacted by a Recruiter
- Career or Job Fair
- Internship
- Interviewed for different position
- Internal communications (Agency/Division, etc.)
- Other (not listed above)
03
In applying for this position, I understand that any offer of employment would be contingent upon me successfully completing a background screening as per the Utah Department of Health and Human Services Background Screening Policy. Link to the policy can be found in the job description.
- Yes
04
Do you have a Medical Degree and current licensure to practice medicine in the State of Utah?
- Yes
- No
05
Please indicate your years of experience with health plan operations.
- No experience
- Less than 1 year
- 1-2 years
- 3-4 years
- 5 or more years
06
Please indicate your years of experience using healthcare quality metrics (HEDIS) to inform health interventions and priorities.
- No experience
- Less than 1 year
- 1-2 years
- 3-4 years
- 5 or more years
07
Please indicate your years of experience with pharmacy benefit management.
- No experience
- Less than 1 year
- 1-2 years
- 3-4 years
- 5 or more years
08
Please indicate your years of experience with medical policy development.
- No experience
- Less than 1 year
- 1-2 years
- 3-4 years
- 5 or more years
Required Question