Job Description

Health plan Chief Medical opportunity! Opportunity resides in Southwestern Location

(please note: This is a hybrid opportunity, but you must live or relocate to the catchment/service area metropolitan area. Not a hybrid from where you presently reside....sorry for confusion! One of the challenges with digital media. Willing to do interim/contract to perm.)

We are representing an exciting opportunity to create a new culture as this established health plan continues on it's growth plan in making sure members have access to the hig-quality healthcare they need and deserve. URAC accreditation for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy.

• The Chief Medical Officer (CMO) serves as the clinical and strategic leader for the Plan, specializing in MEDICAID, CHIP, LTSS, D-SNP, Marketplace and other govt funded insurance programs. Accountable for the oversight and achievement of clinical strategies across Medical Affairs: Quality improvement, Pop Health, Care Management, Behavioral Health, and Utilization Management. This position focuses on driving innovative care models, ensuring regulatory compliance, and fostering provider collaboration to achieve improved member health outcomes, cost-effective care, and health equity. As an executive leader, the CMO collaborates with the Executive Leadership TEam to align clinical objectives with the organization's mission of serving underserved populations through quality, access, and member-centered healthcare services.

• Clinical Strategy & Oversight of managed care programs.
• Care Management and Utilization Review
• Quality Improvement & Accreditation
• Provider Network Engagement & Policy
• Regulatory & Industry Advocacy
• Leadership & Talent Development
• Community & Member Engagement

• The Chief Medical Officer reports the healthplan CEO and serves as key member of the executive leadership team.

 
Current product offerings:

* Medicaid program for low-income children and pregnant women

* Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR

* Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.

*HMO D-SNP, a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.

QUALIFICATIONS:

• Education/Specialized Training/Licensure:
  
  • Unrestricted MD Degree or DO and Licensure,
  • Completion of Residency and Board Certification in Family Medicine, Internal Medicine, Pediatrics or OB/GYN with preference for the Primary Care Specialties
• Work Experience (Years and Area): Fifteen years clinical experience with 10 years of administrative experience in Managed Care, including management of other physicians and/or clinical staff; master's degree in public health, Business Administration or Medical Administration preferred.
  
  • 10+ years leading clinical strategic initiatives for Medicaid,Medicare, and Marketplace insurance products/LOB.
  • 10+ years leading member care quality and affordability initiatives.
  • 10+ years of demonstrated expertise in utilization management, risk adjustment, and care management regulatory compliance.
• Management Experience (Years and Area): 10+ years of administrative experience in Health plan management, including management of other physicians and/or clinical staff.

PREFERRED:

Fellowship or additional certification in Managed Care, Public Health or Health Administration.
Prior experience leading accreditation readiness for NCQA or URAC a plus.
Prior experience with leading Non-Medical Determinants of Health initiatives,

For Immediate Consideration: Send resume/cv to Sue@thi-search.com

Sue Forster

Sue@THI-search.com

Senior Managing Partner

The Healthcare Initiative

720-735-9743

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