Medicaid Medical Director Jobs

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Job ID: 22624
Agency: Department of Social Services Division of Medical Services
Location: Statewide, This position has an option to be remote
Salary: $317,793.60 - $353,101.68 annually, depending on experience
Pay Grade: MO
Closing Date: Open Until Filled

This is a Full-Time position with the Department of Social Services. For more information on the Department of Social Services, please visit https://dss.sd.gov/.

South Dakota Medicaid plays a vital role in the health care of South Dakotans. The program is one of the largest healthcare insurers in South Dakota, covering 140,791 individuals on average in state fiscal year 2022. The program primarily covers children of low‐income families including approximately 50 percent of children in South Dakota under age one. Other individuals covered by South Dakota Medicaid include low-income pregnant women, parents, and other caretaker relatives, seniors in nursing homes, and individuals with physical or developmental disabilities. South Dakota Medicaid anticipates covering an additional 52,000 lives through Medicaid Expansion in South Dakota beginning July 1, 2023.

South Dakota Medicaid is seeking a highly motivated individual with a commitment to service to serve as the Medicaid Medical Director to oversee healthcare quality and population health for individuals covered by Medicaid in South Dakota. This individual will work closely with Medicaid staff in medical/pharmacy policy development, program design and oversight, and, at the direction of Medicaid director, engage with external healthcare providers, community organizations, and government agencies to ensure that members have access to innovative, high-quality, cost-effective healthcare services that promote overall well-being, quality of life, and economical and efficient care. The Medical Director will provide expertise in standards of care and quality of care to ensure that all Medicaid members receive care that meets or exceeds established guidelines.

The Medical Director will report to the Division Director of the Division of Medical Services and have direct oversight of specific medical policy and quality efforts. Duties of the position include:

• State Medical Review Team determinations of disability
• Develop strategies for basic health care that reward good results, measure performance, build partnership, and develop and use evidence of effectiveness.
• Analyze data and utilize evidence-based practices to provide recommendations on decision-making and policy development.
• At the direction of Medicaid director, collaborate with healthcare providers and community organizations to coordinate care and promote preventative services.
• Develop, test, evaluate, adopt and support performance measurement systems (i.e., quality measures) to evaluate care provided to South Dakota Medicaid recipients.
• Advise leadership and partners on the impact of different healthcare delivery models on quality and health outcomes.
• Research and propose innovative approaches for improving the quality, efficiency, and appropriateness of care delivered by Medicaid and Medicaid providers. Seek out best practices and technological solutions or other enhancements.
• Make case by case medical necessity, medical appropriateness and quality of care decisions, and provide guidance to staff and contractors doing the same.
• Stay up-to-date on trends and best practices in healthcare quality and population health.
• Provide expertise in best standards of care.
• Lead and mentor a team of healthcare professionals to achieve performance goals and objectives.
• Authorization programs
• Develop and implement strategies to improve healthcare quality and population health for Medicaid recipients in South Dakota.
• Build and maintain effective working relationships with cross-functional leaders and teams in order to identify, explore, present and implement clinical opportunities.
• Provide leadership and coordination for the development and implementation of a cohesive approach to measuring and promoting quality and lead priority-setting process for clinical quality improvement for South Dakota Medicaid’s payment and care delivery innovation initiatives.
• Serve as a focal point for quality, clinical, and survey and certification policies for South Dakota Medicaid’s healthcare delivery models.
• Manage utilization and review programs including:
• Hospital admissions utilization activities
• At the direction of Medicaid director, participate in meetings and presentations to stakeholders, including other government agencies, providers, associations, and community groups.

Licenses and Certifications:
Medical degree and current licensure to practice medicine in the state of South Dakota (MD or DO).

The Ideal Candidate Will Have:

• Demonstrated expertise in healthcare quality and population health;
• Robust presentation skills;
• Strong leadership and management experience;
• Ability to analyze data and use evidence-based practices to inform decision-making;
• Commitment to improving the health and well-being of Medicaid recipients in South Dakota.
• Excellent communication and interpersonal skills;

Knowledge, Skills, and Abilities:

• Leadership skills and an ability to lead organizational change;
• Ability to identify, recommend, and implement process improvements and efficiencies;
• Project management skills including managing multiple projects;
• Ability to prepare, review, and analyze reports;
• Ability to analyze and interpret data;
• High attention to detail;
• Ability to conduct strategic planning and problem solving.
• Research and analysis skills;

Additional Requirements: To be considered, please attach your resume.

This position is exempt from the Civil Service Act.

The State of South Dakota does not sponsor work visas for new or existing employees. All persons hired will be required to verify identity and eligibility to work in the United States and complete an Employment Eligibility Verification, Form I-9. The State of South Dakota as an employer will be using E-Verify to complete employment eligibility verification upon hire.

The State of South Dakota offers employer paid health insurance plus eleven paid holidays, generous vacation and sick leave accrual, dental, vision, and other insurance options, and retirement benefits. You can view our benefits information at https://bhr.sd.gov/job-seekers/work-for-state-government/. This position is a member of Class A retirement under SDRS.

Must apply online: https://sodakprod-lm01.cloud.infor.com:1443/lmghr/xmlhttp/shorturl.do?key=LTI
You must apply online, emailed resumes or submissions will not be accepted.
South Dakota Bureau of Human Resources
Telephone: 605.773.3148 Email: [email protected]
http://bhr.sd.gov/workforus
"An Equal Opportunity Employer"