Children's National Medical Center
Medical Director
Children's National Medical Center, Washington, District of Columbia, us, 20022
Overview
This full-time position will require employees to work in the office (D.C.) four (4) days a week. Health Services for Children with Special Needs, Inc (HSCSN is a small, Medicaid Managed Care Organization (health plan) that is contracted with the District of Columbia to administer the Child and Adolescent Supplemental Security Income Program (CASSIP). HSCSN enrollees are eligible for CASSIP if they are between 0 and 26 years and have Supplemental Security Income (SSI) or are considered SSI-eligible. HSCSN is an integrated health plan, providing both physical health and behavioral health services. The Medical Director (for physical health) is a full-time position in the Medical Affairs Department reporting to the Chief Medical Officer and is a physician leader for HSCSN. The medical director routinely participates in activities of the Utilization Management and Care Management Departments including authorization decisions, rounds, multidisciplinary team meetings, and case consultations. The Medical Director is expected to use evidenced-based guidelines, approved clinical criteria and sound clinical judgment in making decisions impacting utilization of services by enrollees. The Medical Director collaborates with the Chief Medical Officer, Chief Quality Officer and Quality Management staff to monitor, evaluate and improve the quality of health services being delivered to HSCSN enrollees. Working with cross-functional teams, the Medical Director will help lead Disease Management programs for HSCSN related to physical health conditions including Asthma, Diabetes, and Obesity. As a leader of HSCSN, serves as a clinical liaison with healthcare providers, community stakeholders, and government agencies on behalf of HSCSN. Participates in the development of organization-wide strategic, medical, quality, medical and business planning and goal setting as related to physical health. The Medical Director must be a physician licensed to practice medicine in the District of Columbia with experience in managing children with medical complexity and disabilities. Responsibilities
Utilization Management: Completes second-level reviews of authorization decisions as assigned by members of the Utilization Management Department and within required timeframes. Utilization Management: Participates in peer-to-peer discussions with relevant physicians as necessary and educates network providers regarding options for care. Utilization Management: Assists in development of medical necessity criteria and other medical policy for HSCSN. Utilization Management: Participates in Home Care Rounds, Inpatient Rounds, and other internal team rounds to discuss HSCSN enrollees. Utilization Management: Assists with evaluation of utilization of services, including under and over-utilization. Care Management: Serves as a medical advisor to care management staff regarding diagnoses, services, and enrollee care plans. Care Management: Helps lead Disease Management program development, design, and implementation as part of a cross-functional team including Medical Affairs, Care Management, Utilization Management, and Quality Management. Care Management: Participates in education of HSCSN Care Management and other staff regarding various topics relevant to the HSCSN population. Quality Management: Participates in activities related to Provider Oversight, Vendor Oversight, and Network Adequacy. Quality Management: Participates in investigations of enrollee grievances as needed. Quality Management: Assists the CQO and Quality team in developing quality and performance metrics. Coverage: Is available to perform functions during normal business hours and participates in a rotation of on-call medical directors as needed and as appropriate. Coverage: Covers for the Chief Medical Officer during vacations and as needed. Organizational Accountabilities: Demonstrates understanding of quality of service and collaborates with co-workers to ensure excellence is achieved. Organizational Accountabilities: Innovates through improvement of care and/or efficiency of operational processes. Organizational Accountabilities: Dedicated to a standard of performance excellence and high quality. Collaboration: Creates a safe environment that encourages brainstorming, creativity and "out-of-the-box" thinking. Collaboration: Encourages a diverse group of people to communicate effectively and embrace creative thinking. Collaboration: Drives the collaborative efforts of the team to achieve goals in the most effective and efficient way. Collaboration: Demonstrates listening and feedback skills. Leadership Skills: Proactively assumes responsibility and accountability for results to include management of organizational change. Leadership Skills: Empowers staff in ensuring a culture of transparency, fairness, respect and excellence. Leadership Skills: Strategically aligns operational and tactical objectives to drive business results. Leadership Skills: Encourages collaboration with team members based on trust, mutual respect, consistent visible support, and open and honest communication. Qualifications
Minimum Education Medical Doctor (M.D.) (Required) Minimum Work Experience 5 years: At least 5 years of clinical practice (following training) in a related specialty. (Required) 2 years: Work experience with a managed care organization is preferred. (Preferred) Required Skills/Knowledge Familiarity with the Medicaid system. Experience with the SSI eligible population. Multidisciplinary team leadership. Required Licenses and Certifications Physician must be a physician with a current license to practice without restriction in the District of Columbia 60 Days, (Required) Board Certification in Pediatrics, Internal Medicine or Family Medicine (Required) Job Functions Utilization Management: Completes second-level reviews of authorization decisions as assigned by members of the Utilization Management Department and within required timeframes. Utilization Management: Participates in peer-to-peer discussions with relevant physicians as necessary and educates network providers regarding options for care. Utilization Management: Assists in development of medical necessity criteria and other medical policy for HSCSN. Utilization Management: Participates in Home Care Rounds, Inpatient Rounds, and other internal team rounds to discuss HSCSN enrollees. Utilization Management: Assists with evaluation of utilization of services, including under and over-utilization. Care Management: Serves as a medical advisor to care management staff regarding diagnoses, services, and enrollee care plans. Care Management: Helps lead Disease Management program development, design, and implementation as part of a cross-functional team including Medical Affairs, Care Management, Utilization Management, and Quality Management. Care Management: Participates in education of HSCSN Care Management and other staff regarding various topics relevant to the HSCSN population. Quality Management: Participates in activities related to Provider Oversight, Vendor Oversight, and Network Adequacy. Quality Management: Participates in investigations of enrollee grievances as needed. Quality Management: Assists the CQO and Quality team in developing quality and performance metrics. Coverage: Is available to perform his/her function during normal business hours and participates in a rotation of on-call medical directors as needed and as appropriate. Covers for the Chief Medical Officer during vacations and as needed. Organizational/Leadership Attributes Demonstrates understanding of quality of service and collaborates with co-workers to ensure excellence is achieved Innovates through improvement of care and/or efficiency of operational processes. Dedicated to a standard of performance excellence and high quality Creates a safe environment that encourages brainstorming, creativity and "out-of-the-box" thinking Encourages a diverse group of people to communicate effectively and embrace creative thinking Drives the collaborative efforts of the team to achieve goals in the most effective and efficient way Demonstrates listening and feedback skills Proactively assumes responsibility and accountability for results to include management of organizational change Empowers staff in ensuring a culture of transparency, fairness, respect and excellence Strategically aligns operational and tactical objectives to drive business results. Encourages collaboration with team members based on trust, mutual respect, consistent visible support, and open and honest communication. Location Primary Location: District of Columbia-Washington Work Locations HSCSN - Vermont Ave 1101 Vermont Ave NW Washington, 20005 Job
Physicians / Physicians Leadership Organization
Strategic Operations Position Status
Regular - FT Job Posting
Jul 25, 2025, 4:12:00 PM Full-Time Salary Range
150000 - 450000
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This full-time position will require employees to work in the office (D.C.) four (4) days a week. Health Services for Children with Special Needs, Inc (HSCSN is a small, Medicaid Managed Care Organization (health plan) that is contracted with the District of Columbia to administer the Child and Adolescent Supplemental Security Income Program (CASSIP). HSCSN enrollees are eligible for CASSIP if they are between 0 and 26 years and have Supplemental Security Income (SSI) or are considered SSI-eligible. HSCSN is an integrated health plan, providing both physical health and behavioral health services. The Medical Director (for physical health) is a full-time position in the Medical Affairs Department reporting to the Chief Medical Officer and is a physician leader for HSCSN. The medical director routinely participates in activities of the Utilization Management and Care Management Departments including authorization decisions, rounds, multidisciplinary team meetings, and case consultations. The Medical Director is expected to use evidenced-based guidelines, approved clinical criteria and sound clinical judgment in making decisions impacting utilization of services by enrollees. The Medical Director collaborates with the Chief Medical Officer, Chief Quality Officer and Quality Management staff to monitor, evaluate and improve the quality of health services being delivered to HSCSN enrollees. Working with cross-functional teams, the Medical Director will help lead Disease Management programs for HSCSN related to physical health conditions including Asthma, Diabetes, and Obesity. As a leader of HSCSN, serves as a clinical liaison with healthcare providers, community stakeholders, and government agencies on behalf of HSCSN. Participates in the development of organization-wide strategic, medical, quality, medical and business planning and goal setting as related to physical health. The Medical Director must be a physician licensed to practice medicine in the District of Columbia with experience in managing children with medical complexity and disabilities. Responsibilities
Utilization Management: Completes second-level reviews of authorization decisions as assigned by members of the Utilization Management Department and within required timeframes. Utilization Management: Participates in peer-to-peer discussions with relevant physicians as necessary and educates network providers regarding options for care. Utilization Management: Assists in development of medical necessity criteria and other medical policy for HSCSN. Utilization Management: Participates in Home Care Rounds, Inpatient Rounds, and other internal team rounds to discuss HSCSN enrollees. Utilization Management: Assists with evaluation of utilization of services, including under and over-utilization. Care Management: Serves as a medical advisor to care management staff regarding diagnoses, services, and enrollee care plans. Care Management: Helps lead Disease Management program development, design, and implementation as part of a cross-functional team including Medical Affairs, Care Management, Utilization Management, and Quality Management. Care Management: Participates in education of HSCSN Care Management and other staff regarding various topics relevant to the HSCSN population. Quality Management: Participates in activities related to Provider Oversight, Vendor Oversight, and Network Adequacy. Quality Management: Participates in investigations of enrollee grievances as needed. Quality Management: Assists the CQO and Quality team in developing quality and performance metrics. Coverage: Is available to perform functions during normal business hours and participates in a rotation of on-call medical directors as needed and as appropriate. Coverage: Covers for the Chief Medical Officer during vacations and as needed. Organizational Accountabilities: Demonstrates understanding of quality of service and collaborates with co-workers to ensure excellence is achieved. Organizational Accountabilities: Innovates through improvement of care and/or efficiency of operational processes. Organizational Accountabilities: Dedicated to a standard of performance excellence and high quality. Collaboration: Creates a safe environment that encourages brainstorming, creativity and "out-of-the-box" thinking. Collaboration: Encourages a diverse group of people to communicate effectively and embrace creative thinking. Collaboration: Drives the collaborative efforts of the team to achieve goals in the most effective and efficient way. Collaboration: Demonstrates listening and feedback skills. Leadership Skills: Proactively assumes responsibility and accountability for results to include management of organizational change. Leadership Skills: Empowers staff in ensuring a culture of transparency, fairness, respect and excellence. Leadership Skills: Strategically aligns operational and tactical objectives to drive business results. Leadership Skills: Encourages collaboration with team members based on trust, mutual respect, consistent visible support, and open and honest communication. Qualifications
Minimum Education Medical Doctor (M.D.) (Required) Minimum Work Experience 5 years: At least 5 years of clinical practice (following training) in a related specialty. (Required) 2 years: Work experience with a managed care organization is preferred. (Preferred) Required Skills/Knowledge Familiarity with the Medicaid system. Experience with the SSI eligible population. Multidisciplinary team leadership. Required Licenses and Certifications Physician must be a physician with a current license to practice without restriction in the District of Columbia 60 Days, (Required) Board Certification in Pediatrics, Internal Medicine or Family Medicine (Required) Job Functions Utilization Management: Completes second-level reviews of authorization decisions as assigned by members of the Utilization Management Department and within required timeframes. Utilization Management: Participates in peer-to-peer discussions with relevant physicians as necessary and educates network providers regarding options for care. Utilization Management: Assists in development of medical necessity criteria and other medical policy for HSCSN. Utilization Management: Participates in Home Care Rounds, Inpatient Rounds, and other internal team rounds to discuss HSCSN enrollees. Utilization Management: Assists with evaluation of utilization of services, including under and over-utilization. Care Management: Serves as a medical advisor to care management staff regarding diagnoses, services, and enrollee care plans. Care Management: Helps lead Disease Management program development, design, and implementation as part of a cross-functional team including Medical Affairs, Care Management, Utilization Management, and Quality Management. Care Management: Participates in education of HSCSN Care Management and other staff regarding various topics relevant to the HSCSN population. Quality Management: Participates in activities related to Provider Oversight, Vendor Oversight, and Network Adequacy. Quality Management: Participates in investigations of enrollee grievances as needed. Quality Management: Assists the CQO and Quality team in developing quality and performance metrics. Coverage: Is available to perform his/her function during normal business hours and participates in a rotation of on-call medical directors as needed and as appropriate. Covers for the Chief Medical Officer during vacations and as needed. Organizational/Leadership Attributes Demonstrates understanding of quality of service and collaborates with co-workers to ensure excellence is achieved Innovates through improvement of care and/or efficiency of operational processes. Dedicated to a standard of performance excellence and high quality Creates a safe environment that encourages brainstorming, creativity and "out-of-the-box" thinking Encourages a diverse group of people to communicate effectively and embrace creative thinking Drives the collaborative efforts of the team to achieve goals in the most effective and efficient way Demonstrates listening and feedback skills Proactively assumes responsibility and accountability for results to include management of organizational change Empowers staff in ensuring a culture of transparency, fairness, respect and excellence Strategically aligns operational and tactical objectives to drive business results. Encourages collaboration with team members based on trust, mutual respect, consistent visible support, and open and honest communication. Location Primary Location: District of Columbia-Washington Work Locations HSCSN - Vermont Ave 1101 Vermont Ave NW Washington, 20005 Job
Physicians / Physicians Leadership Organization
Strategic Operations Position Status
Regular - FT Job Posting
Jul 25, 2025, 4:12:00 PM Full-Time Salary Range
150000 - 450000
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