Children's National Medical Center
Medical Director
Children's National Medical Center, Washington, District of Columbia, us, 20022
Job Overview
This full‑time position requires 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 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 physician leader in the Medical Affairs Department reporting to the Chief Medical Officer. The director routinely participates in Utilization Management and Care Management activities—including authorization decisions, rounds, multidisciplinary team meetings, and case consultations—and applies evidence‑based guidelines in making decisions that impact 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 delivered to HSCSN enrollees. Working with cross‑functional teams, the director helps lead disease‑management programs for physical health conditions such as asthma, diabetes, and obesity, and serves as a clinical liaison with healthcare providers, community stakeholders, and government agencies on behalf of HSCSN.
The director participates in the development of organization‑wide strategic, medical, quality, business planning, and goal setting related to physical health, and must be a physician licensed to practice medicine in the District of Columbia with experience in managing children with medical complexity and disabilities.
Job Functions Utilization Management
Completes second‑level reviews of authorization decisions as assigned by the Utilization Management Department within required timeframes.
Participates in peer‑to‑peer discussions with relevant physicians and educates network providers regarding care options.
Assists in developing medical necessity criteria and other medical policies for HSCSN.
Participates in home‑care, inpatient, and other internal team rounds to discuss HSCSN enrollees.
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.
Helps lead disease‑management program development, design, and implementation as part of a cross‑functional team.
Participates in education of HSCSN care‑management and other staff on topics relevant to the HSCSN population.
Quality Management
Participates in provider oversight, vendor oversight, and network adequacy activities.
Investigates enrollee grievances as needed.
Assists the CQO and quality team in developing quality and performance metrics.
Coverage & Availability
Available during normal business hours and participates in a rotation of on‑call medical directors as needed.
Covers for the Chief Medical Officer during vacations and as needed.
Qualifications
Minimum Education:
Medical Doctor (M.D.) – Required.
Minimum Work Experience:
At least 5 years of clinical practice in a related specialty – Required; 2 years with a managed care organization – Preferred.
Required Skills/Knowledge:
Familiarity with the Medicaid system and the SSI‑eligible population; multidisciplinary team leadership.
Required Licenses and Certifications:
Current unrestricted medical license in the District of Columbia (within 60 days); Board certification in Pediatrics, Internal Medicine, or Family Medicine – Required.
EEO Statement DC residents are encouraged to apply.
#J-18808-Ljbffr
Health Services for Children with Special Needs, Inc (HSCSN) is a small Medicaid Managed Care Organization 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 physician leader in the Medical Affairs Department reporting to the Chief Medical Officer. The director routinely participates in Utilization Management and Care Management activities—including authorization decisions, rounds, multidisciplinary team meetings, and case consultations—and applies evidence‑based guidelines in making decisions that impact 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 delivered to HSCSN enrollees. Working with cross‑functional teams, the director helps lead disease‑management programs for physical health conditions such as asthma, diabetes, and obesity, and serves as a clinical liaison with healthcare providers, community stakeholders, and government agencies on behalf of HSCSN.
The director participates in the development of organization‑wide strategic, medical, quality, business planning, and goal setting related to physical health, and must be a physician licensed to practice medicine in the District of Columbia with experience in managing children with medical complexity and disabilities.
Job Functions Utilization Management
Completes second‑level reviews of authorization decisions as assigned by the Utilization Management Department within required timeframes.
Participates in peer‑to‑peer discussions with relevant physicians and educates network providers regarding care options.
Assists in developing medical necessity criteria and other medical policies for HSCSN.
Participates in home‑care, inpatient, and other internal team rounds to discuss HSCSN enrollees.
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.
Helps lead disease‑management program development, design, and implementation as part of a cross‑functional team.
Participates in education of HSCSN care‑management and other staff on topics relevant to the HSCSN population.
Quality Management
Participates in provider oversight, vendor oversight, and network adequacy activities.
Investigates enrollee grievances as needed.
Assists the CQO and quality team in developing quality and performance metrics.
Coverage & Availability
Available during normal business hours and participates in a rotation of on‑call medical directors as needed.
Covers for the Chief Medical Officer during vacations and as needed.
Qualifications
Minimum Education:
Medical Doctor (M.D.) – Required.
Minimum Work Experience:
At least 5 years of clinical practice in a related specialty – Required; 2 years with a managed care organization – Preferred.
Required Skills/Knowledge:
Familiarity with the Medicaid system and the SSI‑eligible population; multidisciplinary team leadership.
Required Licenses and Certifications:
Current unrestricted medical license in the District of Columbia (within 60 days); Board certification in Pediatrics, Internal Medicine, or Family Medicine – Required.
EEO Statement DC residents are encouraged to apply.
#J-18808-Ljbffr