Associate Medical Director or Medical Director DOE

Associate Medical Director or Medical Director DOE

Hybrid role (3 days/week in office) at our Salt Lake City, Boise, Fargo, Portland, Vancouver, Renton, Medford, Burlington, Lewiston, Little Rock and Springdale offices.

Preference will be given to current employees and candidates who reside within a commutable distance from our Salt Lake City, Boise, Fargo, Lewiston, Little Rock and Springdale offices or who are willing to relocate.

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.  

Who We Are Looking For: 

Every day, Cambia’s dedicated team of physicians are living our mission to make health care easier and lives better. As a member of the Physician Review team, our Associate Medical Director and Medical Directors physicians will participate in utilization management and provide clinical leadership and support to clinical teams to ensure our members receive quality, cost effective care yielding optimal outcomes – all in service of creating a person-focused health care experience.

Are you a motivated and experienced medical professional looking for a new challenge? Do you have a passion for patient care and want to make a big difference in healthcare? Then this role may be the perfect fit. 

What You Bring to Cambia: 

Qualifications:  

• Licensed Physician with an MD or DO degree
• Minimum 3 years clinical experience, or equivalent combination of education and experience.
• Active, unrestricted license to practice medicine in one or more states or territories of the United States, with one of these licenses in our four-state area (OR, WA, ID, UT). Applicant must also live in four state area. Board Certification required. Qualification by training and experience to render clinical opinions about medical conditions, procedures and treatments under review.

Skills and Attributes: 

• Provides clinical leadership for staff to ensure members receive safe, effective and cost efficient services.
• Contributes to the development of various medical management strategies and tactics to drive results and achieve key performance metrics.
• Conducts peer clinical review for medical necessity on utilization management authorization requests.
• Provides clinical input on case management reviews working closely with the CM clinical staff.
• Responsible for discussing review determinations with providers who request peer-to-peer conversations.
• Participates on multiple teams to provide clinical input on medical policy reviews and development and may participate on committees that develop programs impacting clinical interventions, utilization management and case management.
• Analyzes and uses data to guide the development and implementation of health care interventions that improve value to the member and employer.
• Advises Health Care Services Leaders on related key performance metrics and the effectiveness of various efforts, initiatives, policies and procedures.
• Identifies and communicates new opportunities in utilization management, provider contracting or other areas that would enhance outcomes and the reputation of the organization.
• Provides clinical expertise and coordinates between internal clinical programs and providers of care to improve the quality and cost of care delivered to health plan members.
• Ensures ethical decision making in compliance with contractual arrangements, regulations and legislation.
• Supports internal communication or training that ensures service is provided to members and providers by a well-trained staff.
• Promotes provider understanding of utilization management and quality improvement policies, procedures and standards.
• Provides guidance and oversight for clinical operational and clinical decision-making aspects of the program.
• May participate in health plan credentialing operations and clinical aspects of the credentialing program and provider services support.
• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired.

What You Will Do at Cambia:

• Demonstrated competency working with hospitals, provider groups or integrated delivery systems to effectively manage patient care to improve outcomes.
• Strong communication and facilitation skills with internal staff and external stakeholders, including the ability to resolve issues and seek optimal outcomes.
• Proven ability to develop and maintain positive working relationships with community and provider partners.
• Knowledge of the health insurance industry, state and federal regulations, provider reimbursement methods and evolving accountable care and payment models.
• General business acumen including understanding of market dynamics, financial/budget management, data analysis and decision making. 
• Strong orientation to the application of data in managing health and quality.
• Proven ability to develop creative strategies to accomplish goals and objectives, plan and execute complex projects and programs and drive results across internal teams and/or external partners.
• Demonstrated ability to effectively lead and engage in a constructive manner with others.

#LI-Hybrid

Pay ranges vary based on the candidate's work location. The expected hiring range depends on skills, experience, education, and training; relevant licensure / certifications; and performance history.

Associate Medical Director

National pay structure — applies to the Boise and Lewiston, ID; Salt Lake City, UT, Oregon and Washington. The full salary range is $207,000 - $337,000. and the bonus target is 18%. The expected salary range is $220,200 - 297,900. 

Medical Director

National pay structure — applies to the Boise and Lewiston, ID; Salt Lake City, UT, Oregon and Washington. The full salary range is $227,000 - $370,000 and the bonus target is 20%. The expected salary range is $241,400 - $326,600.  

About Cambia

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care.  Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Why Join the Cambia Team?

At Cambia, you can:  

• Work alongside diverse teams building cutting-edge solutions to transform health care.  
• Earn a competitive salary and enjoy generous benefits while doing work that changes lives.  
• Grow your career with a company committed to helping you succeed. 
• Give back to your community by participating in Cambia-supported outreach programs.  
• Connect with colleagues who share similar interests and backgrounds through our employee resource groups.  

We believe a career at Cambia is more than just a paycheck – and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.  

In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include: 

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits. 
• Annual employer contribution to a health savings account.  
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays. 
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period). 
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave). 
• Award-winning wellness programs that reward you for participation. 
• Employee Assistance Fund for those in need. 
• Commute and parking benefits. 

Learn more about our benefits. 

We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.

As part of our security requirements, new hires will need access to a personal mobile device to set up Multi-Factor Authentication (MFA) upon joining the company. MFA is an important layer of protection for accessing Cambia systems and is required for all employees.