Chief Medical Officer

Chief Medical Officer The Chief Medical Officer is responsible for clinical strategy, initiatives, and clinical innovation to improve member experience, quality, and cost. Specific responsibilities include development of provider networks and relationships; establishing quality-based service contracts; and establishing and implementing standards to ensure the quality of the medical care provided to Health Options Members. Responsibilities Serve as a member of the Executive Team of Health Options. Drive clinical strategy (Value: policies and programs that promote health and wellbeing and Cost Control). Provide leadership, strategic planning, and strategy execution for medical services. Design and negotiate provider contracts in concert with our Provider Network Department that pays for quality outcomes. Analyze data from multiple sources to identify and respond to trends and /or emerging issues. Plan, direct and oversee the suite of clinical initiatives. Design clinical interventions, programs, and policies to simultaneously improve overall health outcomes and reduce the costs of care. Provide medical oversight of care and disease management initiatives. Work with Utilization Management staff and vendor partners on pre‑authorization, concurrent, retrospective review, and case‑management issues. Oversee, and at times directly lead, the development, planning and management of complex cases and direct management of care coordination with internal providers and clinical staff. Plan and direct clinical approaches in support of the patient‑centered health home initiative. Direct behavioral treatment integration into the daily process of care management. Direct and integrate pharmacy initiatives. Oversee and direct vendor/partner resources in the coordination of patient care. Provide medical expertise based on comprehensive knowledge of health‑care delivery systems, utilization, and treatment protocols. Chair clinical/quality committee(s) focusing on health‑care outcomes and service improvements and report directly to executive leadership and the Health Options Board on committee recommendations. Provide consultation on appeals review process. Provide clinical perspective and guidance on provider credentialing, profiling, and network development. Oversee, direct, and supports the rendering of clinical management decisions that maximize Members’ health improvements within the scope and parameters of policies and applicable plan designs. Monitor effectiveness of management practices through clinical perspectives and the lens of key indicators using data from a wide range of sources and include a focus on efficacy, cost, and satisfaction among Members and constituents. Assure the ongoing development and implementation of policies and procedures that guide and support the provision of clinical programs and care management services. Prepare and submit reports as necessary in an accurate and timely manner. Serve as liaison with external parties and institutions as needed, including public and governmental entities. Oversee and manage clinical audits, assisting inspectors and surveyors in the performance of their duties, and provides reports as required to follow‑up. Contribute towards an effective process for staff development and retention. Possesses strong leadership: a strong grasp of business fundamentals, the ability to influence, visionary and strategic thinking, strong analytical skills, and the ability to build constructive, trusting relationships. Maintains a working knowledge of applicable National, State, and local laws and regulations, JCAHO, NCQA and other regulatory requirements affecting Health Options clinical operations. Participates in professional organizations and represents Community Health Options in a professional, competent manner in the community. Diversity, Equity, and Inclusion Statement Community Health Options is committed to fostering, cultivating, and preserving a culture of diversity, equity, and inclusion (DEI). Our human capital is the single most valuable asset we have. The collective sum of individual differences, life experiences, knowledge, inventiveness, innovation, self‑expression, unique capabilities, and talent our employees invest in their work represents a significant part of not only our culture, but our reputation and achievement as well. Community Health Options DEI initiatives are applicable, but not limited to, our practices and policies on recruitment and selection; compensation and benefits; professional development, and training; promotions; transfers; social and recreational programs, and the ongoing development of a work environment built upon the premise of DEI, which encourages and enforces: Respectful, open communication and cooperation between all employees. Teamwork and participation, encouraging the representation of all groups and employee perspectives. Balanced approach to work culture through flexible schedules to accommodate varying needs of our people. Employer and employee contributions to the communities we serve to promote a greater understanding and respect for each other. Qualifications and Core Requirements MD or DO with unrestricted medical license in Maine required. Minimum of five or more years of direct clinical experience in area of clinical practice, insurance leadership experience in a leadership role in medical staff organization activities, and management experience within a health care delivery system. Management of a staff or approximately 30 professionals within the department. Board certification in medical management preferred. #J-18808-Ljbffr