Medical Director - PRN

Job Description - Medical Director - PRN (250002CD)

Job Description

Medical Director - PRN - ( 250002CD )

Description

Health Services for Children with Special Needs, Inc (HSCSN is a small, Medicaid Managed Care Organization (health plan) that is 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 PRN position in the Medical Affairs Department reporting to the Chief Medical Officer and is a physician leader for HSCSN. The medical director routinely participates in activities of the Utilization Management and Care Management Departments including authorization decisions, rounds, multidisciplinary team meetings, and case consultations. The Medical Director is expected to use evidenced-based guidelines, approved clinical criteria and sound clinical judgment in making decisions impacting 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 being delivered to HSCSN enrollees. Working with cross-functional teams, the Medical Director will help lead Disease Management programs for HSCSN related to physical health conditions including Asthma, Diabetes, and Obesity. As a leader of HSCSN, serves as a clinical liaison with healthcare providers, community stakeholders, and government agencies on behalf of HSCSN.

Participates in the development of organization-wide strategic, medical, quality, medical and business planning and goal setting as related to physical health.

The Medical Director must be a physician licensed to practice medicine in the District of Columbia with experience in managing children with medical complexity and disabilities.

Qualifications

Minimum Education

Medical Doctor (M.D.) (Required)

Minimum Work Experience

5 years At least 5 years of clinical practice (following training) in a related specialty. (Required)

2 years Work experience with a managed care organization is preferred. (Preferred)

Required Skills / Knowledge

Familiarity with the Medicaid system.

Experience with the SSI eligible population.

Multidisciplinary team leadership.

Required Licenses and Certifications

Physician Must be a physician with a current license to practice without restriction in the District of Columbia 60 Days, (Required) Board Certification in Pediatrics, Internal Medicine or Family Medicine (Required)

Job Functions

Utilization Management :

• Completes second-level reviews of authorization decisions as assigned by members of the Utilization Management Department and within required timeframes.
• Participates in peer-to-peer discussions with relevant physicians as necessary and educates network providers regarding options for care.
• Assists in development of medical necessity criteria and other medical policy for HSCSN.
• Participates in Home Care Rounds, Inpatient Rounds, and other internal team rounds to discuss HSCSN enrollees.
• Assists with evaluation of utilization of services, including under and over-utilization.

Care Management :

Quality Management :

Coverage :

Organizational Accountabilities

Organizational Accountabilities (Managers)

Leadership Excellence

Leadership Skills

Supervisory Responsibilities

Blood Borne Pathogen Exposure

Protected Health Information Access Level

Working Environment

Physical Requirements

Travel Requirements

DC Residents Encouraged to Apply.

Hourly Rate :

Minimum : $72.12 - Maximum : $216.35

Primary Location

Primary Location

: District of Columbia-Washington

Work Locations

Work Locations

: HSCSN - Vermont Ave 1101 Vermont Ave NW Washington 20005

Job

Organization

Organization

: Strategic Operations

Job Posting

Job Posting

: Aug 15, 2025, 10 : 00 : 15 AM

Childrens National Hospital is an equal opportunity employer that evaluates qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender, identity, or other characteristics protected by law. The “Know Your Rights” poster is available here : and the pay transparency policy is available here : Know Your Rights Pay Transparency Nondiscrimination Poster.

Please note that it is the policy of Children's National Hospital to ensure a “drug-free” work environment : a workplace free from the illegal use, possession or distribution of controlled substances (as defined in the Controlled Substances Act), or the misuse of legal substances, by all staff (management, employees and contractors). Though recreational and medical marijuana are now legal in the District of Columbia, Children's National and its affiliates maintain the right, in accordance with our policy, to enforce a drug-free workplace, including prohibiting recreational or prescribed marijuana.

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