The Nebraska Medicaid program is seeking a motivated and energetic individual to serve as its senior clinical and quality leader. The Nebraska Division of Medicaid and Long-Term Care, a division of the Department of Health and Human Services, has an annual budget over $1.8 billion and is responsible for the provision of health coverage to nearly 240,000 Nebraskans through Medicaid and the Children's Health Insurance Program. The Medical Director will direct clinical staff, provide clinical decision making for the program and play a leading role in developing and leading the program's quality improvement agenda. This individual will be expected to work with and help to coordinate the efforts of the respective medical directors of the Medicaid managed care organizations (MCOs) operating in Nebraska to pursue joint and harmonized efforts to improve the quality of care and outcomes for all Medicaid recipients in the state.
To be considered for this position, please send your resume to Holly.Socha@Nebraska.gov and address the subject line as, "MLTC Medical Director"
Examples of Work
The Medical Director will be the senior clinical leader for Nebraska Medicaid and oversee the medical management of the Nebraska Medical Assistance Plan which provides benefits for medical and health-related services to individuals and populations qualifying for assistance under the program. This includes fee for service, managed care and other healthcare delivery system arrangements. Specific areas of responsibility include quality, safety, utilization, care management, disease management, pharmacy, credentialing, medical policy, medically-related contract oversight support, dental services, analytics, clinical best practices development and coding for clinical services. The Medical Director is responsible for providing leadership, direction, and administrative support including improvement in clinical care, safety, and resource management. As an integral member of the Executive Management Team the Medical Director will take a leadership role in developing and implementing strategic initiatives. On behalf of Nebraska Medicaid and the state of Nebraska, this individual will be called upon to provide input regarding the review process for medically-related claims and serve occassionally as an expert witness on legal and regulatory matters involving the provision of Medicaid medical care and services; function as an essential liaison to the Nebraska provider community by participating and/or chairing key Medicaid provider collaborations, including joint committees, medical technical advisory groups and other committees as may be defined.
Qualifications / Requirements
REQUIREMENTS: Holds an unrestricted license in Nebraska to practice medicine (allopathic or osteopathic). Board certification in a recognized specialty of the American Board of Medical Specialists or the Osteopathic equivalent. Knowledge of CMS Medicaid regulations, Nebraska Medicaid policies and procedures, Quality programs including CMS Quality Aims and core measures, National Committee on Quality Assurance, Joint Commission, and other programs as identified.
PREFERRED: A master's degree is preferred but not required (MBA, MPH, MHA, MPA, other). Five years of clinical experience, preferably involving the Medicaid population and the medically fragile.
OTHER: Valid driver's license or the ability to provide independent authorized transportation.
Knowledge, Skills and Abilities
Knowledge of the changing healthcare environment including managed care, innovating and emerging payment models, population health principles, federal health care initiatives, and other new developments in health care regulations and delivery of services. Ability to analyze medical data and information, identify trends and develop improvement strategies to improve clinical care and manage healthcare costs. Capacity for strategic planning and execution management. Ability to meet deadlines, prioritize work, multi-task and maintain composure in complex situations and fast-paced and changing environment. This is a sampling of knowledge, skills and abilities being sought in the top candidate. Other identified qualities will be relayed to interested parties who submit an email as specified under the job duties section above.