CareSource
Vice President, Market Chief Medical Officer(Preferred Experience in Behavioral
CareSource, Oklahoma City, Oklahoma, United States
Overview
Vice President, Market Chief Medical Officer (Preferred Experience in Behavioral Health & Managed Care) – R10642 at CareSource. The Vice President, Market Chief Medical Officer has accountability for ensuring that local health plan initiatives focusing on clinical excellence, quality improvement, appropriate inpatient and outpatient utilization, affordability, health system transformation including provider network, regulatory compliance, growth and other focused improvements are implemented and successfully managed to achieve goals. Responsibilities
Primary responsibility and accountability for Total Medical PMPM performance and targets for the health plan, achieved by close collaboration with relevant enterprise stakeholders. Participate in hospital Joint Operations Committee meetings with prioritized providers, share data with physicians and physician groups on quality and efficiency improvements, perform peer-to-peer communications for quality of care, and implement local and national Health Care Affordability Initiatives to achieve inpatient and outpatient utilization and affordability goals. Oversee the HEDIS and CMS Stars data collection process and local performance strategy, CAHPS improvement strategy, drive Health Plan accreditation activities, quality rating improvement initiatives, and other clinical interventions for the local health plan. Ensure achievement of goals for contractually required clinical Quality Performance Indicators and state regulator-driven pay-for-quality initiatives. Oversee market peer review processes including Quality of Care and Quality of Service issues; lead the Physician Advisory Committee (PAC), Quality Management Committee (QMC) and other related committees. Engage with external constituents (consumers/members, physicians, medical and specialty societies, hospitals and hospital associations, regulators) and act as outward face to State regulators as directed; provide clinical thought leadership with external entities and the state. Lead strategy to identify clinical areas with disparities in health outcomes and develop approaches to close gaps, supporting the team in maintaining NCQA Multi-Cultural Distinction designation. Drive quality improvement and provider incentive models; set targets, lead implementation and ongoing leadership during monthly Joint Operating Committees (JOCs). Deliver the clinical value proposition focused on quality, affordability and service in support of growth activities of the local Health Plan; maintain positive relations with State/local regulatory authorities and Medical Societies. Identify opportunities through enterprise and local Market reviews, healthcare economics analyses; participate in Joint Operating Committees and collaborate with Enterprise Clinical Services, Appeals and Grievances, pharmacy or shared services teams. Lead and influence Health Plan employees, foster teamwork, promote diversity and inclusion, and drive employee engagement. Develop and mentor others, identify high-potential colleagues, and manage underperformance. Set clear performance goals, communicate expectations, motivate the team, and focus on customer needs while simplifying non-critical efforts. Communicate effectively, listen actively, and convey genuine interest. Perform any other job duties as requested. Education And Experience
Completion of an accredited Medical Degree program (MD) or Doctor of Osteopathic Medicine (DO) is required. Successful completion of a residency training program, preferably in primary care. Minimum of five (5) years of clinical practice experience with strong knowledge of the managed care industry and the Medicaid line of business. Minimum of two (2) years of Quality management experience. Familiarity with current medical issues and practices. Competencies, Knowledge And Skills
Proven ability to execute and drive improvements against stated goals. Strong leadership, team-building, and effectiveness in a highly matrixed organization. Excellent interpersonal and presentation skills for clinical and non-clinical audiences. Ability to develop relationships with network and community physicians and other providers. Excellent project management, data analysis and interpretation skills; focus on key metrics. Strategic thinking with ability to communicate a vision and drive results; negotiation and conflict management skills; creative problem-solving. Proficiency with Microsoft Office applications. Licensure And Certification
Current, unrestricted medical license required in the state of practice to meet regulatory requirements. Board Certification, preferably in a primary care specialty; recertification as required by the specialty board. Influenza vaccination is a requirement for designated positions during influenza season (October 1 – March 31); annual proof of vaccination may be required. CareSource adheres to all federal, state, and local regulations and provides reasonable accommodations where required by law. Working Conditions
General office environment; may be required to sit or stand for extended periods. May be required to work evenings/weekends. Ability to travel as required by business needs. Compensation
$250,000+; CareSource considers education, training, experience, role scope, and other data when establishing salary. Bonus may be available based on company and individual performance. Total rewards package offered.
#J-18808-Ljbffr
Vice President, Market Chief Medical Officer (Preferred Experience in Behavioral Health & Managed Care) – R10642 at CareSource. The Vice President, Market Chief Medical Officer has accountability for ensuring that local health plan initiatives focusing on clinical excellence, quality improvement, appropriate inpatient and outpatient utilization, affordability, health system transformation including provider network, regulatory compliance, growth and other focused improvements are implemented and successfully managed to achieve goals. Responsibilities
Primary responsibility and accountability for Total Medical PMPM performance and targets for the health plan, achieved by close collaboration with relevant enterprise stakeholders. Participate in hospital Joint Operations Committee meetings with prioritized providers, share data with physicians and physician groups on quality and efficiency improvements, perform peer-to-peer communications for quality of care, and implement local and national Health Care Affordability Initiatives to achieve inpatient and outpatient utilization and affordability goals. Oversee the HEDIS and CMS Stars data collection process and local performance strategy, CAHPS improvement strategy, drive Health Plan accreditation activities, quality rating improvement initiatives, and other clinical interventions for the local health plan. Ensure achievement of goals for contractually required clinical Quality Performance Indicators and state regulator-driven pay-for-quality initiatives. Oversee market peer review processes including Quality of Care and Quality of Service issues; lead the Physician Advisory Committee (PAC), Quality Management Committee (QMC) and other related committees. Engage with external constituents (consumers/members, physicians, medical and specialty societies, hospitals and hospital associations, regulators) and act as outward face to State regulators as directed; provide clinical thought leadership with external entities and the state. Lead strategy to identify clinical areas with disparities in health outcomes and develop approaches to close gaps, supporting the team in maintaining NCQA Multi-Cultural Distinction designation. Drive quality improvement and provider incentive models; set targets, lead implementation and ongoing leadership during monthly Joint Operating Committees (JOCs). Deliver the clinical value proposition focused on quality, affordability and service in support of growth activities of the local Health Plan; maintain positive relations with State/local regulatory authorities and Medical Societies. Identify opportunities through enterprise and local Market reviews, healthcare economics analyses; participate in Joint Operating Committees and collaborate with Enterprise Clinical Services, Appeals and Grievances, pharmacy or shared services teams. Lead and influence Health Plan employees, foster teamwork, promote diversity and inclusion, and drive employee engagement. Develop and mentor others, identify high-potential colleagues, and manage underperformance. Set clear performance goals, communicate expectations, motivate the team, and focus on customer needs while simplifying non-critical efforts. Communicate effectively, listen actively, and convey genuine interest. Perform any other job duties as requested. Education And Experience
Completion of an accredited Medical Degree program (MD) or Doctor of Osteopathic Medicine (DO) is required. Successful completion of a residency training program, preferably in primary care. Minimum of five (5) years of clinical practice experience with strong knowledge of the managed care industry and the Medicaid line of business. Minimum of two (2) years of Quality management experience. Familiarity with current medical issues and practices. Competencies, Knowledge And Skills
Proven ability to execute and drive improvements against stated goals. Strong leadership, team-building, and effectiveness in a highly matrixed organization. Excellent interpersonal and presentation skills for clinical and non-clinical audiences. Ability to develop relationships with network and community physicians and other providers. Excellent project management, data analysis and interpretation skills; focus on key metrics. Strategic thinking with ability to communicate a vision and drive results; negotiation and conflict management skills; creative problem-solving. Proficiency with Microsoft Office applications. Licensure And Certification
Current, unrestricted medical license required in the state of practice to meet regulatory requirements. Board Certification, preferably in a primary care specialty; recertification as required by the specialty board. Influenza vaccination is a requirement for designated positions during influenza season (October 1 – March 31); annual proof of vaccination may be required. CareSource adheres to all federal, state, and local regulations and provides reasonable accommodations where required by law. Working Conditions
General office environment; may be required to sit or stand for extended periods. May be required to work evenings/weekends. Ability to travel as required by business needs. Compensation
$250,000+; CareSource considers education, training, experience, role scope, and other data when establishing salary. Bonus may be available based on company and individual performance. Total rewards package offered.
#J-18808-Ljbffr