[Hiring] Chief Medical Officer @Lumeris

Role Description

Provides strategic direction and clinical expertise to guide policy, programs, and overall healthcare delivery. Functions in a clinical operations role as a member of the operations team and serves as the clinical lead for Essence Healthcare to ensure the delivery of high quality, cost effective and patient centered care.

Primary Responsibilities

• Oversees, coaches, mentors, motivates, supports, and develops a cross-functional team of seasoned people leaders with a broad scope.
• Responsible for overseeing and coordinating all clinical aspects of the health plan, including medical and pharmacy management, utilization review, and initiatives to ensure care and services provided align with evidence-based guidelines and best practices.
• Ultimately responsible for medical cost management.
• Plans and facilitates medical director meetings to ensure effective communication and collaboration.
• Fosters strong relationships with Essence physicians and partners with medical groups on provider performance management.
• Participates in the alignment of physician incentives, quality measures, and value-based contracts.
• Maintains strong relationships with ARO Value Based Care Enablement CMOs and clinical teams at partnering organizations.
• Directs and monitors medical management activities and quality management programs as needed to maintain compliance with CMS, NCQA and other accrediting bodies.
• Collaborates with the Corporate Chief Medical Officer (CCMO) on clinical strategy, design and approach, facilitating communications, and managing risk on engagements.
• Acts as an internal consultant on clinical program development and special projects for Lumeris customers.
• Provides support to the Accountable Delivery Systems Institute as needed on matters relating to accountable care, physician engagement/alignment, payer and clinical transformation, and the use of top technology in support of the new models of care.
• Contributes to the Clinical thought leadership of the organization through presentations, case studies and scientific articles.

Qualifications

• MD. or D.O. degree, plus Board Certification
• Current, unrestricted medical license
• 15+ years of relevant experience or the knowledge, skills, and abilities to succeed in the role
• 7+ years of people, program, or project leadership experience or the knowledge, skills, and abilities to succeed in the role
• Demonstrated experience in a successful clinical practice
• Substantial Medicare Advantage experience
• Proven health system, health plan or capitated provider experience with exposure to managing total cost of care, quality, and documentation and coding
• Deep understanding of population health & managed care
• Strong background in administrative clinical leadership
• Solid understanding and experience with population health management strategies
• Knowledge of healthcare financing and the relation to various managed care products (HMO, PPO, Indemnity, and Medicare Advantage)
• Knowledge of continuous quality improvement theory and practice
• Excellent communication and problem-solving skills
• Demonstrated track record of developing productive working relationships internally and externally at all levels
• Expert ability to positively impact results

Benefits

• Medical, Vision and Dental Plans
• Tax-Advantage Savings Accounts (FSA & HSA)
• Life Insurance and Disability Insurance
• Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days)
• Employee Assistance Program
• 401k with company match
• Employee Resource Groups
• Employee Discount Program
• Learning and Development Opportunities
• And much more...