Chief Medical Officer - Health Plan/Managed Care
The HealthCare Initiative Texas, United States (Hybrid)
Health plan Chief Medical opportunity! Opportunity resides in Southwestern Location
(please note: This is a hybrid opportunity, but you must live or relocate to the catchment/service area metropolitan area. Not a hybrid from where you presently reside....sorry for confusion! One of the challenges with digital media.)
We are representing an exciting opportunity to create a new culture as this established health plan continues on it's growth plan in making sure members have access to the hig-quality healthcare they need and deserve. URAC accreditation for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy.
- The Chief Medical Officer (CMO) has accountability for the clinical strategy for Medical Affairs, Quality, and Medical Management all while building sustainable programs that promote innovative ways to achieve improved outcomes for our members. These responsibilities include care management oversight, quality/STAR rating improvements, appropriate utilization, health system transformation and implementation of medical programs/policies, enhancing relationships with providers and facilities, industry policy advocacy, and regulatory agencies.
- The CMO will be responsible for driving excellent results for all clinical affordability, quality, population health, growth, Net Promoter Score, and external relationship initiatives. Additional plan medical directors, pharmacy, quality, and others report to this position.
- The Chief Medical Officer reports the healthplan CEO and serves as key member of senior executive team.
Current product offerings:
* Medicaid program for low-income children and pregnant women
* Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR
* Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.
*HMO D-SNP, a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.
QUALIFICATIONS:
- Education/Specialized Training/Licensure: Unrestricted MD Degree or DO and Licensure, Completion of Residency and Board Certification in Family Medicine, Internal Medicine, Pediatrics or OB/GYN with preference for the Primary Care Specialties
- Work Experience (Years and Area): Twelve years clinical experience with 5 years of administrative experience in Managed Care, including management of other physicians and/or clinical staff; master's degree in public health, Business Administration or Medical Administration preferred.
- Management Experience (Years and Area): 5 years of administrative experience in Health plan management, including management of other physicians and/or clinical staff.
For Immediate Consideration: Send resume/cv to Sue@thi-search.com
Sue Forster
Senior Managing Partner
The Healthcare Initiative
720-735-9743