CareSource
Vice President, Market Chief Medical Officer(Must Live in Georgia) - R11067
CareSource, New York, New York, United States
Vice President, Market Chief Medical Officer (Must Live in Georgia) - R11067
Join CareSource as the Vice President, Market Chief Medical Officer. This executive role focuses on implementing local health plan initiatives, driving clinical excellence, and ensuring quality and affordability across inpatient and outpatient services.
Job Summary The Vice President, Market Chief Medical Officer leads the execution and management of clinical strategy and quality improvement initiatives. Responsibilities include optimizing provider networks, ensuring compliance with regulations, driving growth, and delivering value through innovative care models.
Essential Functions
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, share data with physicians and physician groups on quality and efficiency improvement opportunities, and implement local and national Health Care Affordability Initiatives.
Analyze medical expense trends and utilization patterns to inform enterprise strategy and market interventions.
Manage total medical expenses incurred in delivering care, ensuring the quality and effectiveness of direct clinical care delivered by clinicians.
Oversee HEDIS, CMS Stars, CAHPS data collection, and local performance strategy; enhance health plan accreditation and quality rating initiatives.
Achieve goals for contractually required clinical quality indicators and state regulator‑driven pay‑for‑quality initiatives.
Lead market peer review processes, including Quality of Care and Quality of Service issues, and chair Physician Advisory Committee (PAC), Quality Management Committee (QMC), and related committees.
Engage external constituents (consumers, physicians, medical societies, hospitals, regulators) as the outward face to state regulators and provide clinical thought leadership.
Develop strategies to close gaps in health outcomes across populations and support NCQA Multi‑Cultural Distinction designation.
Drive quality improvement and provider incentive models, oversee the clinical model end‑to‑end, and support CareSource’s Accountable Care Platform, patient‑centered medical homes, accountable care organizations, and network optimization.
Promote a clinical value proposition focused on quality, affordability, and service, supporting growth activities of the local health plan.
Identify opportunities through enterprise and local market reviews, healthcare economics analyses, and joint operating committees.
Lead and influence health‑plan employees, fostering teamwork, engagement, and diversity and inclusion initiatives.
Develop and mentor colleagues, manage performance, and maintain focus on the company’s mission and strategic goals.
Communicate expectations, present effectively, listen actively, and convey genuine interest.
Perform any other job‑related duties as requested.
Education and Experience
Doctor of Osteopathic Medicine (DO) or Medical Doctor (MD) from an accredited institution.
Successful completion of a residency training program, preferably in primary care.
Five (5) years of clinical practice with strong knowledge of managed care and Medicaid.
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 skills with a record of improved results, team building, and effectiveness in a matrixed organization.
Excellent interpersonal and presentation skills for clinical and non‑clinical audiences.
Proven ability to develop relationships with network and community physicians and other providers.
Excellent project management, data analysis, and negotiation skills.
Strategic thinking, creative problem‑solving, and conflict management.
Proficiency with Microsoft Office applications.
Licensure and Certification
Current, unrestricted medical license in the state of practice.
Board Certification, preferably in primary care specialty.
Re‑certification maintained as required by specialty board.
Annual influenza vaccination required; proof of vaccination verified during the influenza season.
CareSource provides reasonable accommodations for qualified individuals with disabilities, medical conditions, or sincerely held religious beliefs.
Working Conditions
General office environment, may require sitting or standing for extended periods.
May need to work additional or outside normal business hours to meet deadlines.
Travel required as needed for departmental needs.
Compensation Range $250,000+ in base salary. Additional compensation may include performance‑based bonus and a comprehensive total rewards package.
Compensation Type Salary
Competencies
Fostering a collaborative workplace culture
Cultivating partnerships
Developing self and others
Driving execution and inspiring the organization
Influencing others, pursuing personal excellence, and understanding the business.
CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
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Job Summary The Vice President, Market Chief Medical Officer leads the execution and management of clinical strategy and quality improvement initiatives. Responsibilities include optimizing provider networks, ensuring compliance with regulations, driving growth, and delivering value through innovative care models.
Essential Functions
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, share data with physicians and physician groups on quality and efficiency improvement opportunities, and implement local and national Health Care Affordability Initiatives.
Analyze medical expense trends and utilization patterns to inform enterprise strategy and market interventions.
Manage total medical expenses incurred in delivering care, ensuring the quality and effectiveness of direct clinical care delivered by clinicians.
Oversee HEDIS, CMS Stars, CAHPS data collection, and local performance strategy; enhance health plan accreditation and quality rating initiatives.
Achieve goals for contractually required clinical quality indicators and state regulator‑driven pay‑for‑quality initiatives.
Lead market peer review processes, including Quality of Care and Quality of Service issues, and chair Physician Advisory Committee (PAC), Quality Management Committee (QMC), and related committees.
Engage external constituents (consumers, physicians, medical societies, hospitals, regulators) as the outward face to state regulators and provide clinical thought leadership.
Develop strategies to close gaps in health outcomes across populations and support NCQA Multi‑Cultural Distinction designation.
Drive quality improvement and provider incentive models, oversee the clinical model end‑to‑end, and support CareSource’s Accountable Care Platform, patient‑centered medical homes, accountable care organizations, and network optimization.
Promote a clinical value proposition focused on quality, affordability, and service, supporting growth activities of the local health plan.
Identify opportunities through enterprise and local market reviews, healthcare economics analyses, and joint operating committees.
Lead and influence health‑plan employees, fostering teamwork, engagement, and diversity and inclusion initiatives.
Develop and mentor colleagues, manage performance, and maintain focus on the company’s mission and strategic goals.
Communicate expectations, present effectively, listen actively, and convey genuine interest.
Perform any other job‑related duties as requested.
Education and Experience
Doctor of Osteopathic Medicine (DO) or Medical Doctor (MD) from an accredited institution.
Successful completion of a residency training program, preferably in primary care.
Five (5) years of clinical practice with strong knowledge of managed care and Medicaid.
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 skills with a record of improved results, team building, and effectiveness in a matrixed organization.
Excellent interpersonal and presentation skills for clinical and non‑clinical audiences.
Proven ability to develop relationships with network and community physicians and other providers.
Excellent project management, data analysis, and negotiation skills.
Strategic thinking, creative problem‑solving, and conflict management.
Proficiency with Microsoft Office applications.
Licensure and Certification
Current, unrestricted medical license in the state of practice.
Board Certification, preferably in primary care specialty.
Re‑certification maintained as required by specialty board.
Annual influenza vaccination required; proof of vaccination verified during the influenza season.
CareSource provides reasonable accommodations for qualified individuals with disabilities, medical conditions, or sincerely held religious beliefs.
Working Conditions
General office environment, may require sitting or standing for extended periods.
May need to work additional or outside normal business hours to meet deadlines.
Travel required as needed for departmental needs.
Compensation Range $250,000+ in base salary. Additional compensation may include performance‑based bonus and a comprehensive total rewards package.
Compensation Type Salary
Competencies
Fostering a collaborative workplace culture
Cultivating partnerships
Developing self and others
Driving execution and inspiring the organization
Influencing others, pursuing personal excellence, and understanding the business.
CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
#J-18808-Ljbffr