Overview

At St. Luke's Health Plan, we're on a mission to connect people with affordable, hassle-free health care. We are the only health plan in Idaho putting doctors and insurance on the same team to deliver a more efficient and quality health care experience with less stress. Join us in this bold ambitious journey!

A key member of our Medical Affairs department, the Medical Director will work closely with the Chief Medical Officer and other clinical leaders to support the delivery of high-quality healthcare services to our members. This position requires a strong clinical background, a commitment to health equity, and a deep understanding of healthcare systems, population health management, managed care, and utilization management.

Key Responsibilities:

Clinical Leadership and Oversight: Support the Medical Director in leading clinical initiatives and strategies, ensuring that healthcare services are delivered effectively, efficiently, and in accordance with industry best practices and regulatory requirements. Provide timely utilization management, case management, and behavioral health support related to preauthorization, appeals, peer-to-peer discussions, clinical rounds, and daily operations.

Utilization Management: Assist in the development and implementation of utilization management programs, ensuring that care provided to members is medically necessary, evidence-based, and cost-effective. Provide leadership and accountability for efficient, timely and evidence-based medical policy development.

Care Coordination: Collaborate with clinical teams to support care coordination efforts, particularly for high-risk members, and contribute to improving member outcomes through preventive care, chronic disease management, and resource optimization.

Quality Improvement: Assist in the design and execution of quality improvement initiatives, monitor clinical performance metrics, and ensure compliance with state and federal regulations, as well as accreditation standards. Monitor and report on key quality metrics, driving continuous improvement in healthcare outcomes

Clinical Consultation and Education: Provide guidance and consultation to internal staff, including case managers, nurses, and other clinical personnel, to ensure the best possible care for members. Support educational efforts to improve clinical practices and outcomes across the organization.

Collaboration with External Stakeholders: Build strong relationships with internal and external providers, healthcare systems, and community organizations to support the delivery of integrated, patient-centered care.

Data Analysis and Reporting: Review and analyze clinical data to assess trends, identify areas for improvement, and contribute to decision-making on clinical programs and policies, including accountability for medical programs and associated data collection and reporting requirements.

Health Equity Initiatives: Champion health equity within the organization and community by advocating for policies and practices that reduce disparities and promote access to care for all members, particularly those from underserved and vulnerable populations.

Qualifications:

• Medical degree (MD or DO) from an LCME accredited institution.
• Current medical license in the state of Idaho.
• Current Board certification in a specialty recognized by the American Board of Medical Specialties (ABMS).
• 5 years of clinical practice experience, preferably in an outpatient, managed care, or public health setting.

Why St. Luke's

At St. Luke's, caring for people in the communities we serve is our mission - and this includes our own SLHS team. We offer a robust benefits package to support our teams both professionally and personally. In addition to a competitive salary and retirement plans, we ensure our team feels supported in their benefits beyond the typical medical, dental, and vision offerings. We care about you and have fantastic financial and physical wellness options, such as: on-site massages, on-site counseling via our Employee Assistance Program, access to the Virgin Pulse Wellness tool, as well as other formal training and career development offerings to ensure you are meeting your career goals.

St. Luke's is an equal opportunity employer and does not discriminate against any person on the basis of race, religion, color, gender, gender identity, sexual orientation, age, national origin, disability, veteran status, or any other status or condition protected by law.

*Please note: this posting is not reflective of all job duties and responsibilities and is intended to provide an overview to job seekers.