The Associate Medical Director implements utilization review, care management, and clinical practice improvement initiatives for behavioral health. They lead medical management operations and serve as a medical spokesperson for the health plan in provider expansions and contract negotiations.
CareOregon
11 Remote Job Openings at CareOregon
The role focuses on the senior-level design and development of data models, ETL specifications, and enterprise data architecture. Responsibilities include establishing data standards, performing complex data analysis, and managing vendor relations.
Lead large-scale, complex enterprise projects and programs utilizing LEAN and project management principles. Act as a liaison between internal and external stakeholders to facilitate collaboration and ensure the successful implementation of technology-focused initiatives.
Responsible for the timely review, investigation, and adjudication of Medicaid, Medicare, and private medical, dental, and mental health claims. The role involves ensuring compliance with plan provisions and regulatory requirements while meeting quality and production standards.
Lead the design, implementation, and management of corporate security technologies and policies to mature the organization's security model. Partner with business leaders to balance operational needs with risk mitigation and oversee vendor relations for security services.
Supports utilization management functions including benefit review, appeals, grievances, and health-related services to ensure medically appropriate care. Collaborates with Medical Directors to determine medical necessity and manages authorizations according to state and federal guidelines.
Administer fraud, waste, and abuse (FWA) duties to prevent, detect, and correct irregularities within CareOregon. This includes performing investigations, conducting audits, and preparing regulatory reports for internal and external stakeholders.
Administer fraud, waste, and abuse (FWA) duties to prevent, detect, and correct irregularities within CareOregon and its affiliates. This includes performing advanced investigations, preparing regulatory reports, and developing FWA dashboards to monitor compliance trends.
Perform senior-level accounting functions including general ledger maintenance, complex account reconciliations, and advanced data analysis. Responsible for preparing monthly financial reporting packages, regulatory filings, and supporting year-end audits.
Lead large-scale, complex enterprise projects from scoping through implementation using LEAN and project management principles. Act as a primary liaison between internal and external stakeholders to ensure collaboration, accountability, and alignment with strategic plans.
Perform comprehensive data analysis and visualization to support healthcare quality improvement initiatives using tools like Tableau and SQL. Develop dashboards and provide data-driven insights to inform strategic decisions and ensure regulatory compliance.
