Health Plan Chief Medical Officer - SHCN
The Health Plan Chief Medical Officer has overall accountability and oversight of all Health Plan clinical functions and medical cost trends consistent with the vision and strategy set forth by the senior executive leadership team. Actively involved in the shift toward a value-based, integrated delivery system in collaboration with strategic partners to ensure the delivery of the highest value healthcare services.
Establishes credibility and rapport to collaborate with a broad set of senior executives, clinicians, local government leaders, and community representatives. Participates and supports the communication, education, and maintenance of partnerships with contracted providers, provider physician groups, and may serve as the interface between the Health Plan and providers, regulators, etc.
Manages, mentors, and coaches a high performing team that is focused on clinical quality, service excellence, and business literacy; accountable for the success of Medical Directors contributing to the Arizona Health Plan. Rallies support for the overall corporate vision and able to provide competitive clinical strategies and plans to ensure delivery of the highest value clinical and service outcomes of all communities to which the position is assigned. Responsible for the financial health of the Plan related to medical cost trends.
Collaborates with clinical leadership and key stakeholders to oversee the development and implementation of an effective care management infrastructure, including clinical practice improvement to reduce variation and improve efficiencies. Actively supports Quality and Compliance to ensure the Health Plan meets and exceeds medical management, quality, accreditation, regulatory, and agency standards. Accountable for ongoing monitoring, measurement, and communication of medical management programs and processes (e.g. utilization management, care management, etc.); overseeing analysis of overall medical expense and performance data. Facilitates timely and specific clinical behavior modification that is both clinically sound and cost effective.
Use population health and value-based care management in developing and evaluating systems that fully integrate care and reimbursement across the continuum of health care delivery. Accountable for adoption of evidence-based medical guidelines and protocols with proper stewardship of resources; analyzing members and population data to guide program direction. Participates in the administration of medical management programs to assure that network providers deliver and members receive appropriate, high quality, and cost effective care.
Leads the charge in focus and implementation of the organization's culture and strategic plan in a way that aligns to the mission, vision, and values of the organization. Performs other position appropriate duties as required in a competent, professional, and courteous manner.
MD (Medical Doctor) or DO with an active, unrestricted state medical license required
Board certified in their medical specialty required
MBA or MPH strongly preferred
Minimum of five (5) years of clinical practice experience required
Minimum of five (5) years of managed care experience required
Proficiency with managed care environment with a philosophy of collaboration and teamwork
Excellent verbal and written communication skills with the ability to build consensus
Ability to process map and manage large projects to successful completion