Associate Medical Director

Associate Medical Director


The Washington State Health Care Authority (HCA) purchases health care for more than 2 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, and, beginning in 2020, the School Employees Benefits Board (SEBB) Program. Our agency is committed to whole person care, integrating physical health and behavioral health services for better results and healthier residents. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.
 
Position Objective:
The Health Care Authority's mission is to provide high quality health care through innovative health policies and purchasing strategies. The Clinical Quality and Care Transformation (CQCT) Division is responsible for designing and implementing clinical policy; conducting oversight, including measuring, monitoring, and improving all clinically related programs; and communicating and collaborating with stakeholders, providers, plans, and delivery system partners on clinical activities and issues with the goal to provide a single standard of evidence-informed high-quality care.
 
This position provides clinical leadership to lead the state in care quality and transformation and supports the benefit programs administered by HCA.  Leadership components includes the consideration of health equity initiatives, social determinants of health, provider engagement, patient centered care models, and value-based purchasing.  This position works with public health entities, providers, insurers, and other stakeholders; defines clinical purchasing and funding strategies; aligns resources to goals and strategies; and implements and evaluates the results of clinical leadership efforts.  This position supports care transformation, innovation and value-based care delivery within Apple Health (Medicaid), the Public Employee Benefits Program and the School Employee Benefits Program, impacting over 2.5 million lives and $10B of annual expenditure. 
 
The Associate Medical Director leads Apple Health's evidence-based clinical policies, Washington's Health Technology Assessment Program, and provides the clinical leadership for the nine Accountable Communities of Health (ACHs). This position reports directly to the Chief Medical Officer.

Some of what you will do:
 
Lead Apple Health clinical strategy.

• Lead and support the HCA Health Care Services Section including medical, dental and DME, and the maternal, psychiatry, medical and dental licensed prescribing practitioners.
• Develop, review and update clinical policies, protocols and coverage standards based on review of medical literature, the best available evidence, the requirements of the Center for Medicaid and Medicare Services, State law, governor directive and agency priorities. Consideration will be given to factors related to prior authorization, utilization review and other algorithms used to determine clinical appropriateness, case management services, and comprehensive care management for appropriate members.

 
 Apple Health: Measurement, Monitoring and Improvement.

• Assure that the clinical policies of Medicaid Fee-for-Service and Managed Care Organizations (MCOs) accurately reflect the intent and expectations of the HCA, and are implemented consistently across contracted plans so as to reduce practice variation and assure appropriateness of care. Collaborate effectively with the Divisions of Medicaid Program Operations and Integrity (MPOI); Finance, and other HCA divisions as appropriate to achieve these goals.
• Review and monitor MCO utilization management programs, case management initiatives, utilization review protocols, clinical components of post-payment review and prior authorization (PA) policies for common/priority conditions, procedures and pharmaceuticals to assure appropriateness and consistency with best practice.

 
Statewide Clinical Collaboration.

• Lead the clinical support to the Medicaid Demonstration and Accountable Communities of Health (ACHs) to achieve evidence-based best practices for delivering care. Serve as a clinical leader, liaison and consultant to ACHs and the provider community in support of Healthier WA goals.
• Participate in and, as appropriate, lead statewide clinical collaborations, such as those sponsored by the Washington Health Alliance, Bree Collaborative and others, as directed by the CMO. (For example, work groups that are convened by WHA Clinical Quality Committee or the Bree)

 
Evidence-based clinical policy development, implementation and oversight.

• Lead the Health Technology Assessment program (HTAP) including topic selection, participating agency engagement, appointment of HTCC members, and the functioning of the Committee. Participate as a clinical member of the Health Technology Assessment Workgroup. Clinical members are responsible to critically review and comment on evidence-based reviews conducted as part of the (HTAP); and, when assigned as lead, the development and presentation of AMDG coverage recommendations to the Health Technology Clinical Committee (HTCC).
• Lead the HCA Coverage Parameters team and develop, review, and update as needed clinical policies based on critical review of medical literature and consistent with best available evidence. Create and implement the Apple Health clinical policy and, in specific situations, take into consideration the direction set by the Centers of Medicare and Medicaid Services- Participate as a member of the Washington State Agency Medical Director's Group (AMDG) in the development and implementation of statewide clinical initiatives and/or policies (e.g. AMDG Opiate Prescribing Guideline; Governor's Executive Order on the Opiate Epidemic), and other policy work of the AMDG. Lead selected efforts as needed.

 
Clinical Program Development, Implementation and Oversight.

• Develop and lead clinically oriented statewide HCA initiatives housed in CQCT, engaging diverse and multiple stakeholders both within and outside of state government. The focus of such initiatives will be the quadruple aim – better care, better health, lower costs, and improved work life of health providers. Relevant programs may include the development of primary care support within the Apple Health Program, Medicaid fee-for-service quality tracking, expansion of the Primary Care Medical Homes

 
Administrative and Supervisory Responsibilities within CQCT.

• Participate on Clinical Quality Council
• Assist in bill analysis
• Provide testimony to the legislature