The Chief Medical Officer is an integral member of the executive team and is responsible for building a strong vision, sense of commitment and competence within and between the clinical teams and with other departments of the health plan.
The Chief Medical Officer will be responsible for establishing and maintaining excellent relationships with the provider community. This includes the willingness to meet often with providers to address any issues and to build and maintain provider trust and loyalty.
The Chief Medical Officer is responsible for leadership of the Medical Management programs of the Alameda Alliance for Health (“the Alliance”), including quality & accreditation,utilization management, pharmacy services, credentialing, case management programs and clinical policy formulation.
Together with the leadership of Medical Management Services, Quality Management, Case Management, Pharmacy, the Chief Medical Officer is responsible for the ongoing creation of structure within the these departments, including establishing systems of accountability.
· Develop and implement a strategic vision and plan to deliver seamless health care services to a culturally diverse membership who traditionally lacks access to comprehensive high quality medical care in collaboration with the clinical management teams.
· Work with the Chief Executive Officer, Alliance providers, and members in the community to:
- Develop and advocate for programs and delivery systems that provide high quality, cost effective services.
- Build community support for the Alliance.
- Expand the visibility and influence in order to affect health care policy at the county and state level.
· Consult in the development and implementation of new products and benefits.
· Assist in promoting the use of web technology (e.g. Web, PDA, EPR, etc.) by physicians and consumers in conjunction with the Alliance’s strategies.
· Monitor physician compliance with contractual responsibilities in conjunction with the Network Management department, particularly in the areas of utilization review and quality management.
· Encourage providers to effectively manage the delivery of health care and Alliance members to use the delivery network effectively and appropriately.
· Serve as key intermediary between the Alliance and providers, maintain effective and consistent communications and professional relationships with providers, and represent the concerns and recommendations of physicians.
· Assist in recruitment and orientation of participating Alliance providers.
· Provide clinical consultation and oversight of the Alliance’s clinical programs.
· Perform continuing evaluation and modification of the Alliance’s programs to improve the quality and efficiency of health care delivery.
· Assist in the development of first-rate, collaborative clinical management teams and support inter-departmental communication, cooperation, and collaboration.
· Develop utilization management criteria and clinical protocols for the Alliance, analyze trends, and recommend policy, program, and practice changes designed to achieve outstanding utilization results.
· Assist in the development of an overall strategic direction for clinical, disease management and continuous quality improvement programs.
· Provide oversight of member communication that has clinical information.
· Ensure that medical decisions are rendered by qualified medical personnel, unhindered by fiscal or administrative management.
· Ensure that medical care meets standards for acceptable medical care and establish comprehensive, clear standards of clinical care that identify desirable, observable characteristics of care, based on evidence-based, community, state and national practice guidelines.
· Develop, implement and monitor the health plan’s quality management plans, including monitoring the quality of Medical Services provided to members, credentialing, peer review, grievance monitoring and consumer satisfaction.
· Serve as chair of the Health Care Quality Committee, Peer Review, and Pharmacy and Therapeutics committees and work with ad hoc physician and provider committees.
· Participate in the grievance and external medical review processes and resolve medically related and potential quality related grievances and issues, authorizations, appeals decisions and denials.
· Perform other duties and special projects as assigned.
EDUCATION OR TRAINING EQUIVALENT TO:
· Current Doctor of Medicine, active and unrestricted license in the State of California, Board certified.
MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:
· Two years experience in a managed care environment, physician group management, or integrated health care system management.
· Five years experience in the practice of medicine.
· Five years management experience at executive level.
SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):
· Must have an unrestricted license to practice in the state of California.
· Experience and current knowledge in clinical program administration, including utilization management and quality management.
· Proven track record with tangible results in clinical quality improvement and cost management.
· Ability to think strategically and bring vision to the position.
· Ability to integrate clinical and financial data for improved management of clinical programs.
· Ability to develop and maintain successful working relationships with external constituents, physicians, hospitals, ancillary providers, regulators, government officials and the media.
· Knowledge of California public health care programs.
· Knowledge of Managed Care.
· Experience serving culturally diverse populations.
· Successful track record as a team player, collaborative style, and exceptional interpersonal skills.
· Excellent verbal and written communication skills.
· Proficient experience in Windows Microsoft Office suite.