Associate Chief Medical Officer for Managed Care

stanford•Palo Alto, CA

12d

About The Position

Stanford University School of Medicine seeks an Associate Chief Medical Officer (ACMO) for Managed Care, with an academic appointment in the Clinician Educator line. The primary appointment criterion is excellence in a combination of clinical care, teaching, administration, and/or scholarship aligned with the programmatic needs the individual is expected to fulfill. The ACMO is a physician executive responsible for leading Stanford Medicine Children’s Health’s payer strategy, reimbursement, and access to destination services. The role partners with clinical, operational, and executive leaders to optimize payer relationships, support utilization strategies, improve access to specialized pediatric services, and advance organizational goals related to financial performance and patient experience. The ACMO provides physician leadership on complex payer, authorization, medical necessity, and reimbursement matters; clinical oversight and consultation across revenue cycle, utilization management, and care coordination; and physician education and guidance on practices that mitigate denials and safeguard reimbursement. As a member of the Senior Leadership Team, the ACMO leads strategic programs and partnerships that support Stanford Children's mission and long-term growth.

Requirements

MD/DO or equivalent.
At least 5 years of experience in physician leadership roles in health plans, hospitals, health care systems, or equivalent.
California medical license required upon hiring.

Nice To Haves

Qualified to assume a 25% clinical role in an academic pediatric and obstetric health system setting.
Advanced degree such as an MBA, MHA, or equivalent.
Experience with pediatrics.
Experience with maternity care.
Experience with Epic.
Experience with accountable care entities.
Experience with commercial insurance reimbursement.
Experience with Medicaid insurance reimbursement.

Responsibilities

Provide clinical leadership for payer contracts and denial management strategies.
Cultivate relationships with health plan clinical and administrative leaders, including medical directors and executives.
Partner with payers and Stanford Medicine Children’s Health stakeholders to resolve complex coverage, reimbursement, and access issues, including facilitating Letters of Agreement (LOAs) and single-case agreements.
Collaborate with internal and external stakeholders to improve patient access to specialized pediatric services.
Assist with analysis of reimbursement performance across payers to identify and prioritize improvement opportunities.
Provide physician consultation and oversight for complex utilization management, medical necessity, and care coordination issues.
Serve as the executive escalation point and provide physician consultation on complex financial clearance, authorization, reimbursement, and denial issues for in-network and out-of-network health plans, including out-of-state Medicaid plans.
Partner with Revenue Cycle, Managed Care, Case Management, and Utilization Review teams to address payer challenges and improve reimbursement outcomes.
Identify denial trends and opportunities to improve access to care, financial clearance, and reimbursement.
Oversee the Stanford Children’s International Patient Services (SCIPS) program for international families seeking elective care at Stanford Medicine Children’s Health.
Oversee assigned medical directors working in Case Management, Utilization Management (UM), Clinical Documentation Improvement (CDI), Health Information Management Services (HIMS), financial clearance, and other assigned areas.
Serve with Revenue Cycle Operations as the physician resource for questions, issues, and escalations regarding regulatory and payer requirements for coverage of medically necessary services, financial clearance, and reimbursement.
Educate and coach physicians on documentation, authorization requirements, and payer expectations and guidelines.
Work with operational and clinical leaders to develop guidance and best practices that improve authorization approvals and reduce administrative barriers to care.
Provide guidance to physicians on complex payer, utilization, and access-related issues.
Serve on the Stanford Children's Health Senior Leadership Team.
Provide clinical leadership for the Stanford Health Care Alliance (SHCA) insurance product.
Oversee Lucile Packard Children’s Hospital (LPCH) Case Management functions from a Physician-Nurse Dyad perspective, provide UM expertise to that team, and co-chair the Medical Staff Utilization Review Committee.
Lead Stanford Children's International Patient Services (SCIPS).
Serve on the SMCH Corporate Compliance Committee and the SMCH Committee on Management Controls & Compliance (CMCC).
Serve on relevant SMCH committees, including Effectiveness & Efficiency Oversight, Access Steering, Grievance Payer Strategy, Payer Performance, and the Cell and Gene Therapy Executive Committee.
Assist with relevant issues discussed at health plan Joint Operating Committee (JOC) meetings.
Facilitate cardiovascular financial clearance review meetings.
Provide support as needed to solid and stem cell transplant and gene therapy financial clearance review teams and meetings.
Chair the High-Cost Drug Committee and provide guidance on unique high-cost therapies.