Salary Range: $359,860 - $575,776
Job Summary
The Chief Medical Officer (CMO) is a member of the executive team with strategic leadership responsibility for clinical oversight, physician partnership and quality improvement in support of the organization's vision, mission and values. CenCal Health's vision is to be a trusted leader in advancing health equity so that our communities thrive and achieve optimal health together. The mission of the organization, which the CMO champions, is to improve the health and well-being of the communities we serve by providing access to high-quality services, in addition to outreach and engagement, for our members. Reporting directly to the Chief Executive Officer (CEO), the CMO develops the vision for wellness, quality improvement and provider partnership for the organization, oversees Health Services and serves as a trusted and local liaison to CenCal Health's dedicated provider network. The CMO provides clinical leadership to the organization and is accountable for effective medical decision-making, adherence to professional and ethical medical standards, application of state and health plan policy and overseeing clinical programs for CenCal Health members.
The CMO supervises the Sr. Medical Director, Executive Quality and Population Health Officer (QPHO), Health Services Officer (HSO) and Medical Directors and provides clinical expertise, consultation and support for medical decision-making in the following departments: Quality (Measurement, Improvement and Population Health), Medical Management (UM/CM), Pharmacy and Behavioral Health. The CMO supports an effective and diverse team of healthcare professionals, serves as a back-up for the Medical Directors as needed and leads collaboratively and empathetically.
The CMO serves as the physician liaison to CenCal Health's network of providers, evaluates the needs of CenCal Health's population, identifies wellness priorities for the organization and co-designs initiatives with CenCal Health partners to improve member health outcomes in our communities. In collaboration with the Chief Operating Officer (COO), Executive Quality and Population Health Officer (QPHO), Chief Health Equity Officer (CHEO) and Health Services Officer (HSO), the CMO facilitates cross-functional and organization-wide initiatives in support of CenCal Health's vision, mission and strategic objectives.
The CMO supervises the Quality Improvement System and Quality Improvement & Health Equity Transformation Program (QIHETP), and Quality Improvement & Health Equity Committee (QIHEC) activities, in collaboration with the CHEO at CenCal Health, including broad oversight of provider credentialing, medical education, peer review, quality assurance, quality improvement and member safety/risk management among other functions. The CMO is responsible for overseeing the QIHETP focused on quality and wellness and serves as the Chair of the QIHEC in collaboration with the CHEO focused on health equity.
The CMO holds a strong vision for wellness and health equity for CenCal Health's members, inspiring an organizational culture of team member and provider wellness and quality and championing excellence in care and service for the underserved in our communities. This role provides executive sponsorship for continuous quality improvement initiatives, including support for a data-driven approach to decision-making and reduction of health disparities.
Duties and Responsibilities
Wellness and Quality Vision
- Champions the vision and mission of the organization to improve the health and well-being of the communities we serve by providing access to high-quality services, in addition to outreach and engagement, for our members.
- Develops the Health Services vision for wellness and champions quality improvement, in collaboration with the Executive Quality and Population Health Officer (QPHO) and Health Services Officer (HSO).
- Collaborates with the Executive Team to develop strategic priorities and objectives to support the Health Services vision.
- Designs and leads strategic initiatives that support CenCal Health's provider network in collaboration with the COO and wellness initiatives in collaboration with the Chief Performance Officer (CPO).
- Provides clinical leadership to the organization and is accountable for effective medical decision-making, adherence to professional and ethical medical standards, application of state and health plan policy and overseeing clinical programs for CenCal Health members.
Clinical Oversight
- Ensures that medical decisions are rendered by qualified medical personnel, unhindered by fiscal or administrative management, and responsive to local needs, as allowed within CenCal Health's organization structure.
- Develops and implements quality of care policies and clinical guidelines for CenCal Health's members and oversees provider compliance with clinical guidelines in coordination with the Executive Quality and Population Health Officer (EQPO) and in alignment with the Compliance Program.
- Leads collaboratively and empathetically, supporting a diverse team of healthcare professionals, in collaboration with the HSO, and serves as a back-up for the Medical Directors as needed.
- Provides medical leadership by balancing clinical decisions, health care trends, local considerations and member needs through the following processes: Peer Review, Member Grievances, Appeals, and State Hearings, Corrective Action, Provider Credentialing and Re-Credentialing, Quality Measurement and Improvement, Clinical Reviews and Medical Determinations.
- Supervises the Sr. Medical Director, QPHO, HSO and Medical Directors and provides clinical expertise, consultation and support for medical decision-making in the following departments: Quality (Measurement, Improvement and Population Health), Medical Management (UM/CM), Pharmacy and Behavioral Health.
- In collaboration with the Medical Director(s), Health Services Director, Pharmacy Director, and Behavioral Health Director, supports clinical decision-making for the prospective, concurrent and retrospective reviews of inpatient and long-term care services; issuing denial of services when appropriate; participating in appeal review and reviewing other medical claims and appeals as necessary.
- Consults on the development of plans and policies related to health promotion for CenCal Health members and continuing education for providers.
- Supports organization in understanding the broad and deep issues of the healthcare environment both locally and nationally.
Physician Liaison
- The CMO serves as the physician liaison to CenCal Health's network of providers, evaluates the needs of CenCal Health's population and co-designs initiatives with CenCal Health partners to improve member health outcomes in our communities.
- Serves as a clinical leader and subject matter expert in the community through visibility, participation in collaborative efforts, and by maintaining strong relationships with community providers and stakeholders.
- Promotes CenCal Health and builds relationships as a physician liaison to the San Luis Obispo and Santa Barbara County medical communities, including championing the health for the underserved, communicating goals, objectives and business principles and supporting CenCal Health's policies, procedures and decisions.
- Participates in strategic planning efforts and ongoing management meetings by communicating business strategies from a clinical perspective and serves as a physician partner within the medical community.
- In collaboration with the COO, CHEO and HSO, the CMO facilitates cross-functional and organization-wide initiatives in support of CenCal Health's vision, mission and strategic objectives.
- Collaborates on the development and implementation strategic goals related to planning, implementation, quality improvement, and ongoing management of clinical programs.
- Provides proactive medical leadership consistent with CenCal Health's Strategic Plan around business transformation.
Quality Improvement
- The CMO supervises the QIHETP at CenCal Health, including broad oversight of provider credentialing, medical education, peer review, quality assurance, quality improvement and member safety/risk management among other functions.
- In collaboration with the Sr. Medical Director and QPHO, the CMO is responsible for overseeing the Quality Improvement System and the QIHETP.
- Provides executive sponsorship for continuous quality improvement initiatives, including support for a data-driven approach to decision-making and reduction of health disparities.
- Serves as the Chair of the QIHEC in collaboration with the CHEO, and on committees as delineated in the QAIP, partners within community provider committees and advisory boards and maintains an active status with the medical community.
- Participates in the grievance process regarding quality of care issues, holding the ultimate responsibility for the resolution of medically related grievances.
The CMO holds a strong vision for wellness, quality and health equity for CenCal Health's members, inspiring an organizational culture of wellness, quality and championing excellence in care and service for the underserved in our communities.
- Provides executive sponsorship for wellness and continuous quality improvement initiatives, including support for a data-driven approach to decision-making and reduction of health disparities.
- Provides strategic executive leadership to continually promote CenCal Health's commitment to pursuing a more equitable health care system for all members.
- Provides strategic executive leadership for health equity performance and monitoring, program policy changes and interventions and diversity, equity and inclusion activities.
Other duties as assigned.
Knowledge/Skills/Abilities
- Experience in public health and/or Medi-Cal managed care as well as familiarity with California regulations, wellness initiatives, quality standards and requirements.
- Understanding of Medi-Cal populations and safety-net providers, including quality improvement projects and initiatives tailored to medically underserved communities.
- Awareness of the various social determinants of health that impact health disparities.
- Knowledge of Santa Barbara and San Luis Obispo communities, including providers and community partners.
- Expertise in overseeing quality improvement systems, quality programs, social determinants of health, NCQA best practices.
- Working knowledge of health plan utilization management, care management, pharmacy and behavioral health processes including metrics for monitoring and overseeing these programs.
- Ability to direct, manage, supervise, mentor, train and evaluate the work of other clinical and programmatic leaders, including setting objectives and measuring results.
- Ability to make sound clinical judgments and decisions.
- Skilled at assertive and non-judgmental interaction with physician peers and other practitioners to motivate improvements in clinical practice to increase compliance with established clinical guidelines.
- Serves as a lead clinician with strong clinical references and proven track record of programmatic development of successful clinical programs.
- Ability to listen, resolve problems and handle situations with tact and diplomacy.
- Understands the use of data in exploring opportunities for improvements without rushing to judgment.
Ability to motivate others to create extraordinary results, and unite people to turn challenges into successes by embracing The Five Practices of Exemplary Leadership of The Leadership Challenge:
1. Model the Way:
- Clarify values by finding your voice and affirming shared values.
- Set the example by aligning actions with shared values.
2. Inspire a Shared Vision
- Envision the future by imagining exciting and ennobling possibilities.
- Enlist others in a common vision by appealing to shared aspirations.
3. Challenge the Process
- Search for opportunities by seizing the initiative and looking outward for innovative ways to improve.
- Experiment and take risks by consistently generating small wins and learning from experience.
4. Enable Others to Act
- Foster collaboration by building trust and facilitating relationships.
- Strengthen others by increasing self-determination and developing competence.
5. Encourage the Heart
- Recognize contributions by showing appreciation for individual excellence.
- Celebrate the values and victories by creating a spirit of community.
Education and Experience
- Doctor of Medicine, current license to practice medicine issued by the State of California, Board Certification in a specialty recognized by the American Board of Medical Specialties, preferably in primary care.
- Ten (10) years of experience in medical programs within an organized health system with experience leading or consulting on one or more of those clinical areas overseen by the Chief Medical Officer or an equivalent combination of education or experience that would be qualifying.
- Preference to an employment history serving the Medi-Cal population or medically underserved with Medicare experience highly desirable.
