Job Description:
A health client is seeking a Chief Medical Officer (CMO). This leader oversees clinical excellence, quality improvement, appropriate inpatient and outpatient utilization, affordability, health system relationships, regulatory compliance, growth, and other strategic initiatives to achieve organizational goals. This is a retained search.
Responsibilities:
- Hold primary responsibility for the performance of total medical expenses per member per month.
- Collaborate with enterprise stakeholders to manage targets for the health plan.
- Participate in meetings with prioritized providers.
- Share data with physicians and physician groups on quality and efficiency improvement opportunities.
- Complete peer-to-peer communications for quality of care and implement initiatives to achieve inpatient and outpatient utilization and affordability goals.
- Oversee market peer review processes, including quality of care and quality of service issues.
- Effectively engage with external constituents such as members, physicians, medical and specialty societies, hospitals and hospital associations, federal or state regulators, and market-based collaboratives.
- Identify clinical areas with health outcome disparities and create an approach to close these gaps.
- Support the team in maintaining the National Committee for Quality Assurance’s Multicultural Health Care Distinction designation.
- Drive quality improvement and provider incentive models by identifying best practices, initiating contact, setting targets and implementing solutions.
Requirements:
- 3+ years of work experience in commercial health insurance as a medical director or CMO
- 2+ years of clinical practice experience
- Strong knowledge of the managed care industry, Affordable Care Act and Medicaid line of business
- 2+ years of quality management experience
- Completion of an accredited medical degree program as a medical doctor or doctor of osteopathic medicine
- Successful completion of a residency training program
- Successful completion of a residency training program in primary care (preferred)
- Familiarity with current medical issues and practices
- Knowledge of value-based contracting (preferred)
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