Senior Medical Director
Senior Medical Director
Employer Active
Job Alert
You will be updated with latest job alerts via email
Share
Job Alert
You will be updated with latest job alerts via email
$ 329800 - 356300
1 Vacancy
Job Description
Pinnacol Assurance does just one thing and does it better than anyone: provide caring workers compensation protection to Colorado employers and employees. And while we may be a little biased we believe that our work shapes communities and changes lives.
We have big hearts and love big ideas. Weve been around for more than 100 years but dont let that fool you. Pinnacol is committed to taking care of Colorado employers and workers in the most innovative ways. We celebrate continuous improvement new ideas compassion teamwork integrity and excellence.
What youll do:
The Senior Medical Director works collaboratively with Operations Leadership to develop and maintain quality and medical management strategies and network programs. Will be responsible for implementation and evaluation of clinical programs including but not limited to valuebased programs and incentives care outcomes central utilization review and program integrity.
What you can expect:
- Leverages datadriven insights to plan and execute clinical strategies targeting improvement that are consistent with best practices in workers compensation management state and federal regulations.
- Provide meaningful strategic input to senior management clinical staff Physician Advisors regulators and network providers concerning changes in accreditation standards implications of proposed legislature utilization management criteria clinical guidelines delivery system trends and related issues.
- Stays current with and develops strategies to implement leadingedge health technology and informatics. Leverages lean management principles to foster an environment of continuous learning improvement innovation and experimentation.
- Will be responsible for implementation and evaluation of clinical programs including but not limited to valuebased programs and incentives care outcomes utilization management and program integrity.
In conjunction with the AVP and Director of Medical Operations responsible for the development maintenance and evaluation of provider network quality and outcomes. Identify opportunities for continuous improvement in the performance of the network and develop processes to monitor improvement.
- Assumes leadership responsibilities and actively participates as Chair of both the Credentialing and Quality of Service Committee (CQSC) and the Network Affiliation Committee (NAC) to develop and ensure network quality and consistency according to established standards.
- Responsible for the planning directing and monitoring of the Physician Advisor program including training performance evaluation management oversight sharing of best practices and supervision.
- Examines analyzes and reports on network and nonnetwork data trends and outcomes. Recommends and implements initiatives that address quality cost outcomes experience and operations issues.
- Provides clinical expertise and direction that supports appropriate utilization management and application of evidencebased practices.
- Actively supports and communicates network policies and procedures to providers and other medical organizations and works to ensure effective implementation and compliance of policies and procedures.
- Develops and improves provider relations across Colorado communities and actively participates in outreach efforts to expand the network and improve access to quality care for injured workers and policyholders.
Develops and maintains strong provider business and community relationships. Works collaboratively across the organization building strong relationships and influence to improve operational performance and improvement.
- Actively engages with physicians to problemsolve educate coach and otherwise ensure quality and cost effective outcomes. Collaborates with physicians and provider groups on targeted issues.
- Able to build credibility and establish trust within all levels of the organization providers agencies and policyholders.
- Listens interprets negotiates and consensus builds to successfully resolve issues and build support across diverse stakeholder groups.
- Bridges claims and medical management operations to network and providers on complex issues identifying and resolving pain points and identifying opportunities for continuous improvement
- Consults engages and serves as a resource to claims and medical management operations safety and worksite wellness disciplines.
- Serves as a liaison on behalf of Pinnacol to legislative regulatory and legal communities
- Provides education advocacy information and professional development to internal staff Physician Advisors provider groups policymakers and the community.
- Represents the Company in medical affairs through active involvement in county and state medical societies medical specialty societies medical professional organizations and select special engagements.
- Represents the Company on a local regional and /or national level by participating in pertinent research studies or authorship of reports/papers for scientific or trade journals and/or speaker or guest lecturer/instructor at meetings conferences etc. and /or public response as necessary regarding medical matters and managed care issues relevant to Pinnacol.
- Regularly authors and presents various network educational communications articles and research insights to nonclinical audiences positioning Pinnacol as a leading edge business industry and community innovator
- Translates data analytics and complex clinical materials into compelling communications in formal and informal settings
- Review complex workers compensation cases and provide oral and written opinions on the case(s).
Develop and Lead Central Utilization Review Program at Pinnacol
- Work with Med Ops UR Manager and Claims team on planning and implementation of the utilization review (UR) program including budget and ROI projections workflows training materials technical resources and configurations.
- Development of strategic communications related to Pinnacols network performance and UR programs to foster external stakeholder buyin
- Responsible for the evolution of our Centralized Utilization Review program (also emulating URAC standards) requires oversight of medical director to bridge the world of medicine and insurance applying DOWC medical treatment guidelines and working collaboratively with Medical Director of the DOWC
- Other duties as assigned
- Mainly office environment. Must be able to attend meetings industry and community events requiring before/after hours and travel.
What you need to be successful:
- Comprehensive knowledge of managed care processes and systems.
- Extensive experience overseeing effective Utilization Review/Authorization Program.
- Thorough knowledge of Workers Compensation laws industry regulations licensing and accreditation issues.
- Current unrestricted Colorado Board of Medical Examiners License (MD or DO) Current State of Colorado Division of Workers Compensation Level I or II Physician
- Accreditation ABMS or AOA Board Certification in related specialty
- Masters Degree in business health information public administration information systems insurance or other related field is preferred
- Minimum of five years of clinical experience with at least two years in a supervisor or Medical Director position which includes experience in administration of insurance and/or managed care programs.
We cant do our work without people like you.
Our employees are extraordinary and committed to making a difference. Heres some of the ways we show our appreciation.
- Our benefits go beyond the basics. Youll get to choose from diverse benefit offerings for medical dental and vision.
- We care about each other. We enjoy a positive collaborative work environment. We are hard workers and high performers.
- We love who you are. Pinnacol is on a journey to embody diversity equity and inclusion. Were committed to creating a culture that deeply values differences where everyone feels like they belong.
- Take a day (or 20! off. Enjoy 20 paid days off your first full year plus 9 paid holidays.
- Take care of yourself. Sign up for unique wellness programs including onsite companypaid fitness facilities and classes
- Get your learning on. We promote a learning culture to help you master your current job and cultivate the skills of the future through a variety of onsite online and offsite professional development opportunities.
- Give back and get paid. Through our employee volunteer program Pinnacol in Action employees receive paid time off to volunteer with Colorado nonprofits.
- Share in our success. Youll have the opportunity to earn a quarterly incentive up to 12 percent of your annual base salary when your team exceeds their goals and objectives.
When we find the right person we try to put our best foot forward with an offer that excites you. We consider what youd like to be paid the skills and experience you bring what similar jobs pay in the Denver area and make sure theres equal pay for equal work among those youll be working with. The compensation amount for this role is targeted at $329800 to $356300. Final offer amounts are determined by multiple factors including your experience and expertise and may vary from the amounts listed above.
Want to love your work Apply today!
Pinnacol is committed to working with and providing reasonable accommodations to applicants with disabilities. To request assistance with the application process please email .
This posting will close 15 days after being published: April 15 2025
Salary Range
$329800 $356300 USD
Required Experience:
Director
Employment Type
Full Time
