The Chief Medical Officer is responsible for the overall strategicdirection and oversight of the delivery of care of the plan.
This position is responsible for quality management, utilizationreview, credentialing, case management and Pharmacy. Key areas of concentrations include – 1)collaborating on population management strategies, 2) disease managementproducts and programs, 3) data base development and outcomes research,including development, implementation, market research and 4) strategicpartnerships.
This position is the ultimate medical policy decision maker for thecorporation.
Developand implement the strategic plan for medical management population management,outcomes analysis, case management and population management.
Senior Executive level responsibility for direction and oversight of Medical Operationand staff (Quality, Utilization, Credentialing).
Develop and implement new medical managementinitiatives and programs.
Developand maintain relationships with academic institutions for the purposes ofbusiness and research collaboration.
Identify and assess managed care entities forpotential business alliances.
Participate in executive strategic planning atthe corporate level.
Servesas Chair of the Quality Improvement, Utilization management, Credentialing andPeer Review Pharmacy and Therapeutics Committee.
Interactswith provider when discussion will assist in resolving quality or utilizationissues.
Monitorcompany compliance with government and contractual compliance including DMHC,CMS, DHCS and other agencies.
Evaluatesprovider profile data reports, provides consultation, and recommendsintervention, including disciplinary action per policy/ procedure.
Overseethe utilization management guidelines and decisions.
Supportsales and marketing through presentation to key decision makers in clients andprospects
Support corporate counsel in risk managementand contract evaluation.
MINIMUM POSITION REQUIREMENTS:
- Five years of experience in a health plan, medical group or IPA or quality management administrative position.
- Three years of experience in developing and maintaining administrative claims data set for the purposes of outcomes analysis and outcomes management.
- Working knowledge of statistics
United States-California-Fountain ValleyPrimary Location: Schedule: