CHIEF MEDICAL OFFICER (2536)

VIVANT HEALTH•Sacramento, CA

4d•$325,000 - $350,000

About The Position

The Chief Medical Officer (CMO) is a key member of the Senior Executive team, engaged in defining the overall business strategy and direction of the organization. In addition, this position leads the overall clinical vision for the organization and provides clinical direction to the different divisions at Vivant Health, LLC. The position provides medical oversight, expertise and leadership to ensure the delivery of quality healthcare services to Vivant Health Membership. Responsibilities also include the strategy, development and implementation of innovative clinical programs that include collaboration with strategic business partners such as plan sponsors, and regulatory agencies. The CMO participates in the strategic medical management for our plan sponsors. The CMO will partner with Utilization Management to increase effectiveness of medical management programs and promote integration of other medical programs at Vivant Health, LLC. In addition to being a key leader, the CMO will also spend at least half of their time managing the authorization queue as do the Medical Directors.

Requirements

Five (5) + years of clinical practice required.
Two (2) + years of health plan managed care (either with a medical group or health plan) utilization management, health care quality improvement (such as NCQA, CMS), and in the development and implementation of clinical practice guidelines.
Two (2) + years’ experience with Medi-Cal/Medicare required.
Excellent oral and written communication skills, with the ability to communicate professionally with diverse individuals and groups inside and outside of Vivant.
Ability to read, interpret and apply complex written guidelines, instructions and other materials.
Excellent attention to detail and ability to document information accurately.
Demonstrated ability to articulate and embrace organizational values, integrate into management practices, and foster their manifestation among staff.
Excellent active listening and critical thinking skills.
Ability to demonstrate compassion and sensitivity to patients’ needs and concerns.
Ability to consistently deliver excellent customer service.
Ability to exercise sound discretion and strict maintenance of confidentiality of all confidential and sensitive communications and information.
Ability to proactively solve advanced-level problems with minimal supervision.
Ability to demonstrate professionalism, confidence, and sincerity while quickly and positively engaging providers.
Ability to build partnerships and work collaboratively with others to meet shared objectives.
Self-motivated and excellent ability to multi-task, manage time/projects, demonstrate strong organization skills, and ability to meet multiple deadlines.
Ability to effectively and positively work in a dynamic, fast-paced team environment and achieve objectives.
Ability to provide and receive constructive job and/or industry related feedback.
Ability to maintain confidentiality and appropriately share information on a need-to-know basis.
Ability to exercise sound discretion and strict maintenance of confidentiality of all confidential and sensitive communications and information.
Demonstrate commitment to the organization’s mission.
Must have the ability to quickly learn and use new software tools.
Must have mid-level skills using e-mail applications.
Ability to work independently as well as in a team environment.
Ability to present self in a professional manner and represent the Company image.
Medical Degree from an accredited university required
Active and Unrestricted California Physician License

Responsibilities

Main functions of a Medical Director: Managing authorizations in the authorization queue in a timely manner by meeting or exceeding turn around time requirements.
Responsible for a number of activities related to the management of medical care and clinical services such as cost management, utilization review, quality assurance, and medical protocol development.
Oversees the activities of a group of physicians, including the recruiting and credentialing processes.
Keep abreast of emerging models in health care delivery; identify and define new and innovative strategies to achieve business goals and objectives.
Reports to the CEO and/or to the governing body of the organization.
Directorship duties and responsibilities: Attend standing meetings (Board, committee, etc.).
Monitor quality and appropriateness of medical care.
Provide guidance and leadership for performance guidelines.
Assist in development of policies and procedures.
Participate in the management of strategic development.
Participate in clinical peer review oversight.
Participate in documentation and care planning.
Assist in management of physician relations and/or representation.
Assist in adjudication of First Level Provider Appeals Address emergency issues.
Support physician education.
Assist in management of community relations.
Assist in guidance for performance guidelines.
Perform assigned transactional activities: Prior authorization; concurrent review; retro- active review; claim review.
Provides physician oversight of medical care management and utilization review in all RCMG offices.
Provides clinical guidance in complex medical decision processes.
Meet compliance standards: contractual and legislative.
Assist in care management and coordination activities.
Assist in staff training: Physician, Pharmacist, Case Managers, and UM Staff.
Become proficient with company software programs.
Assist in “Carve Out Program” management and develop proficiency with and understanding of Carve Outs (CCS, LEA, etc.).
Assist in coordination activities with contracted Health Plans and County Health Agencies Work with contracted medical providers and business partners to implement programs and resolve problems related to medical case management.
Act as Medical Resource to Vivant Health staff Maintain professional affiliations and enhance professional growth and development to stay current in medical trends.
Adhere to company policies and procedures, guidelines, and directives.
Maintain strict operating and patient confidentiality.
Contributes to a healthy, positive, and safe environment and promotes self as a team member.
Performs related duties consistent with the scope and intent of the position.
Regular attendance.
Travel as required.
Other Functions Enforces Company policies and safety procedures.
Regularly updates job knowledge by participating in educational opportunities, reading professional publications, maintaining professional networks, and participating in professional organizations.
Maintain IPA, Health Plan compliance standards.
Supervisor Responsibility This position supervises several Medical Directors.