Vice President, Market Chief Medical Officer

1 week ago

Indianapolis, Indiana, United States CareSource Full time
Job Summary:

The Vice President, Market Chief Medical Officer is responsible for ensuring the successful implementation and management of local health plan initiatives focusing on clinical excellence, quality improvement, and affordability. This role requires close collaboration with enterprise stakeholders to achieve goals and drive growth.

Key Responsibilities:
  • Primary responsibility for Total Medical PMPM performance and targets for the health plan.
  • Direct the Quality Management and Utilization Management programs, including implementing corrective actions and quality management activities.
  • Deliver the clinical value proposition focused on quality, affordability, and service, in support of growth activities of the local Health Plan.
  • Responsible for 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, and lead the Physician Advisory Committee (PAC), Quality Management Committee (QMC), and other associated committees.
  • Provide oversight to the HEDIS and CMS Stars data collection process and local performance strategy, CAHPS improvement strategy, and drive the achievement and maintenance of Medicaid, Marketplace, and other relevant NCQA accreditation, quality rating improvement initiatives, and other clinical interventions for the local health plan.
  • Oversee the development and implementation of the Contractor's disease management, case management, and care management programs; oversee the development of the Contractor's clinical practice guidelines, 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.
  • Attend all relevant FSSA meetings and take appropriate action as directed by the State.
  • Effectively engage with external constituents, including consumers/members, providers, medical and specialty societies, hospitals, and hospital associations, federal/state regulators, and community-based organizations under the direction of Plan President and CareSource Enterprise Chief Medical Officer.
  • Participate in meetings with providers, share relevant utilization and financial data, complete peer-to-peer communications for quality of care as required, and implement local and national Health Care Affordability Initiatives to achieve inpatient and outpatient utilization and affordability goals.
  • Work closely with the Pharmacy Director to ensure compliance with pharmacy-related responsibilities of the State contract.
  • Collaborate with the Director of Health Equity to develop, implement, and maintain a strategy to identify clinical areas where there are disparities in health outcomes across groups and approach to closing gaps in health outcomes.
  • Actively participate in various enterprise quality, utilization management, care management, and operations committees as directed and work collaboratively with enterprise and 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 of your own strengths and development needs; 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.
Requirements:
  • 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 a plus.
  • A minimum of two (2) years of Quality management experience is desired.
  • 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:
  • Must be an Indiana-licensed Health Care Provider (IHCP) provider.
  • Current, unrestricted license to practice medicine in the 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.
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:

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

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