VP, Chief Medical Officer
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- Dec 14, 2018 Post Date
To provide the clinical leadership for ConnectiCare Medical Operations and Medical Quality both internally and externally.
Responsibilities:
- Hires, develops, manages and motivates a performance-based team to maximize business results.
- Improves the utilization of all medical services by contributing to the strategic direction for medical management programs including case management, prior authorization programs, grievance and appeals, disease management and pharmacy management.
- Responsible for establishing clinical policies and communicates the application of clinical policies internally and externally as they pertain to processes such as utilization management, quality management and pharmacy management. May chair the ConnectiCare Physician Advisory Committee and the EmblemHealth Medical Policy Subcommittee.
- Responsible for reviewing and providing opinions on new technologies and their application in organizational clinical management programs.
- Responsible for articulating Healthcare Management positions related to Operations claims configuration, claims payment and code management. May act as a member of the Code Management Group.
- Works in conjunction with Product and Actuarial to provide input on proposed benefit changes and supports analysis of reports and data sets used to determine their success.
- Works in conjunction with Data Analytics to assess medical trends and utilization and formulate appropriate medical management activities in advance of and response to trend.
- Lead physician supporting case management activities. Is an integral member of the case management teams and resolves case management questions and conflicts including interacting with attending physicians, physician advisors and IPA Medical Directors.
- Develops the skills and medical management capabilities of CCI internal physicians and external physician organizations and their medical directors. Cultivates cooperative relationships with their respective organizations.
- Lead physician participating in the management of pharmacy programs. May act as a member of the Pharmacy and Therapeutic Committee.
- Participates in the management of healthcare vendors including the articulation of medical policy and claims adjudication/configuration consistent with organizational policies and regulatory requirements.
- May, in consultation with other leaders in Health Services, develop, refine and apply credentialing policy in accordance with NCQA standards.
- Acts as the lead Health Services resource concerning Medicare-risk policies and programs as they relate to medical and quality management of a Medicare population.
- Represents Medical Affairs on the Medicare Steering Committee.
- Participates in the development, implementation, ongoing analysis and improvement of new and established Commercial products and associated lines of business.
- Supports Sales/Marketing efforts to create new business opportunities, retain current business, and respond to customer and client needs.
- Performs other related projects and duties as assigned.
Qualifications:
- Licensed Medical Doctor.
- Board certified in area of expertise.
- Primary care specialty or other Medicare population specialty desirable.
- Unrestricted license to practice in CT and other states as appropriate/needed.
- At least 3 years clinical experience.
- Advanced degree desirable.
- Experience with Medicare-risk programs required.
- Experience with the management of IPA, PHO and/or group practice models related to medical utilization, and/or resource management and quality assurance.
- Computer literacy (Microsoft Word, Excel, and Access) desirable as it relates to the ability to manipulate and analyze data.
Company Statement
Careers at EmblemHealth: For nine decades, EmblemHealth has been making quality health care accessible and affordable for New Yorkers, and helping to make life better in the communities we serve. Our employees are proud of that legacy and want to make health care better for everyone. Here we inspire success while helping employees build meaningful careers. We offer competitive health and welfare benefits, retirement benefits, and incentive pay plans. Join us for a rewarding experience.
Pay Disclosure
A good faith estimate of the compensation range for individuals hired to work for the EmblemHealth Family of Companies is provided. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, internal peer equity, and market and business considerations. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. It is not typical for an individual to be hired at or near the top of the range, as compensation decisions depend on each case’s facts and circumstances. Union roles covered by a collective bargaining agreement will compensate in accordance with the union contract.
EEOC Statement
We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.
Sponsorship Statement
Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, Emblemhealth may provide work visa sponsorship for certain positions.
