Chief Medical Officer, Essence Healthcare

Lumeris•Missouri, MO

55d•$238,300 - $350,575•Remote

About The Position

Provides strategic direction and clinical expertise to guide policy, programs, and overall healthcare delivery. Functions in a clinical operations role as a member of the operations team and serves as the clinical lead for Essence Healthcare to ensure the delivery of high quality, cost effective and patient centered care.

Requirements

MD. or D.O. degree, plus Board Certification
Current, unrestricted medical license
15+ years of relevant experience or the knowledge, skills, and abilities to succeed in the role
7+ years of people, program, or project leadership experience or the knowledge, skills, and abilities to succeed in the role
Demonstrated experience in a successful clinical practice
Substantial Medicare Advantage experience
Proven health system, health plan or capitated provider experience with exposure to managing total cost of care, quality, and documentation and coding
Deep understanding of population health & managed care
Strong background in administrative clinical leadership
Solid understanding and experience with population health management strategies
Knowledge of healthcare financing and the relation to various managed care products (HMO, PPO, Indemnity, and Medicare Advantage)
Knowledge of continuous quality improvement theory and practice
Excellent communication and problem-solving skills
Demonstrated track record of developing productive working relationships internally and externally at all levels
Expert ability to positively impact results

Responsibilities

Oversees, coaches, mentors, motivates, supports, and develops a cross-functional team of seasoned people leaders with a broad scope.
Responsible for overseeing and coordinating all clinical aspects of the health plan, including medical and pharmacy management, utilization review, and initiatives to ensure care and services provided align with evidence-based guidelines and best practices.
Ultimately responsible for medical cost management.
Plans and facilitates medical director meetings to ensure effective communication and collaboration.
Fosters strong relationships with Essence physicians and partners with medical groups on provider performance management.
Participates in the alignment of physician incentives, quality measures, and value-based contracts.
Maintains strong relationships with ARO Value Based Care Enablement CMOs and clinical teams at partnering organizations.
Directs and monitors medical management activities and quality management programs as needed to maintain compliance with CMS, NCQA and other accrediting bodies.
Collaborates with the Corporate Chief Medical Officer (CCMO) on clinical strategy, design and approach, facilitating communications, and managing risk on engagements.
Acts as an internal consultant on clinical program development and special projects for Lumeris customers.
Provides support to the Accountable Delivery Systems Institute as needed on matters relating to accountable care, physician engagement/alignment, payer and clinical transformation, and the use of top technology in support of the new models of care.
Contributes to the Clinical thought leadership of the organization through presentations, case studies and scientific articles.