Job Summary:
The Vice President, Market Chief Medical Officer has accountability for ensuring that local health plan, CareSource initiatives focusing on clinical excellence, quality improvement, appropriate inpatient and outpatient utilization, affordability, health system transformation including provider network, compliance with regulatory mandates, growth and other focused improvements are implemented and successfully managed to achieve goals.
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 with prioritized providers, data sharing with physicians and physician groups on quality and efficiency improvement opportunities, completing peer to peer communications for quality of care as required, and implementing local and national Health Care Affordability Initiatives in order to achieve inpatient and outpatient utilization and affordability goals
- Provides oversight to the HEDIS and CMS Stars data collection process and local performance strategy, CAHPS improvement strategy, and drives Health Plan accreditation activities as well as quality rating improvement initiatives and other clinical interventions for the local health plan
- Responsible for achievement of goals for contractually required clinical Quality Performance Indicators and state regulator-driven pay-for-quality initiatives.
- Oversees market peer review processes including Quality of Care and Quality of Service issues, and leads the Physician Advisory Committee (PAC), Quality Management Committee (QMC) and other associated committees.
- Effectively engage with external constituents such as consumers/members, physicians, medical and specialty societies, hospitals and hospital associations, federal/state regulators, and market-based collaboratives; act as the outward face to State regulators based upon Contract, and direction of Plan President and CareSource CMO and should provide clinical thought leadership with external entities and the state
- Lead the development of a strategy to identify clinical areas where there are disparities in health outcomes across groups, and approach to closing gaps in health outcomes; support the team in maintaining NCQA Multi-Cultural Distinction designation
- Drive quality improvement and provider incentive models through identification of appropriate practices; initial contact and target setting, and Implementation, as well as ongoing leadership during monthly JOCs. The Plan CMO is accountable for oversight of the entire clinical model (end to end) within the market, including, but not limited to, CareSource’s Accountable Care Platform, clinical practice transformation, patient-centered medical homes, accountable care organizations, creative care management programs, high-performance networks and network optimization, and consumer engagement.
- Deliver the clinical value proposition focused on quality, affordability and service, in support of growth activities of the local Health Plan; actively promote positive relations with State/local regulatory authorities and Medical Societies
- Responsible for identifying opportunities through participation in enterprise and local Market reviews, and healthcare economics analyses; actively participate in various Joint Operating Committees and work collaboratively with Enterprise Clinical Services, Appeals and Grievances, pharmacy or shared services teams
- Lead and influence Health Plan employees by fostering teamwork and collaboration, driving employee engagement and leveraging diversity and inclusion
- Develop and mentor others while also building awareness to your own strengths and development need; identify and invest in high-potential colleagues; actively manage underperformance
- Focus staff on the company's mission; inspire superior performance; ensure understanding of strategic context; set clear performance goals; focus energy on serving the customer; provide ongoing communication to the team; discontinue non-critical efforts
- Communicate expectations and present effectively, listen actively and attentively to others, and convey genuine interest
- Perform any other job duties as requested
Education and Experience:
- Completion of an accredited Medical Degree program as a medical doctor (MD) or Doctor of Osteopathic (DO) medicine is required
- Successful completion of a residency training program, preferably in primary care is required
- A minimum of five (5) years of clinical practice experience with strong knowledge of managed care industry and the Medicaid line of business is required
- A minimum of two (2) years of Quality management experience is required
- Familiarity with current medical issues and practices
Competencies, Knowledge and Skills:
- Proven ability to execute and drive improvements against stated goals
- Strong leadership skills, as demonstrated by continuously improved results, team building, and effectiveness in a highly matrixed organization
- Excellent interpersonal communication skills
- Superior presentation skills for both clinical and non-clinical audiences
- Proven ability to develop relationships with network and community physicians and other providers
- Excellent project management skills
- Solid data analysis and interpretation skills; ability to focus on key metrics
- Strong team player and team building skills
- Strategic thinking with proven ability to communicate a vision and drive results
- Solid negotiation and conflict management skills
- Creative problem-solving skills.
- Proficiency with Microsoft Office applications
Licensure and Certification:
- Current, unrestricted license to practice medicine in state of practice as necessary to meet regulatory requirements is required
- Board Certification, preferably in primary care specialty is required; re-certification, as required by specialty board, must be maintained
- To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
- CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.
Working Conditions:
- General office environment; may be required to sit or stand for extended periods of time
- May be required to work evenings/weekends
- Ability to travel as required by the needs of the business
Compensation range $150,000-$300,000. CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
Create an Inclusive Environment
Cultivate Partnerships
Develop Self and Others
Drive Execution
Energize and Inspire the Organization
Influence Others
Pursue Personal Excellence
Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.
