Job Description

Job Description:
A health insurance company is seeking a Vice President of Market Chief Medical Officer - Wisconsin. This role is responsible for ensuring that the local health plan and the company’s initiatives related to clinical excellence, quality improvement, appropriate inpatient and outpatient utilization, affordability, health system relationships, regulatory compliance, growth and other strategic improvements are successfully implemented and managed. The vice president oversees the entire clinical model, including but not limited to clinical practice transformation, patient-centered medical homes, accountable care organizations, creative care management programs, high-performance networks, network optimization and consumer engagement. This leader will serve as a resource to the market president and other market staff on medical issues. The Vice President of Market Chief Medical Officer will focus the staff on the company’s mission, inspire superior performance and align the team with strategic vision. This executive will set clear performance goals, emphasize customer service and streamline efforts to focus on critical priorities. This is a retained search.

Responsibilities:

• Hold primary responsibility for Total Medical PMPM performance and targets for the health plan, collaborating closely with relevant enterprise stakeholders.
• Participate in meetings with key providers, sharing data with physicians and physician groups to identify quality and efficiency improvement opportunities.
• Conduct peer-to-peer communications on quality of care as needed and implement initiatives to optimize inpatient and outpatient utilization and affordability.
• Oversee HEDIS and CMS Stars data collection and performance strategy, along with CAHPS improvement strategy.
• Lead health plan accreditation activities, quality rating improvement initiatives and other clinical interventions.
• Ensure achievement of goals related to contractually required quality performance indicators and state regulator-driven pay-for-quality initiatives.
• Lead market peer review processes, including quality-of-care and quality-of-service issues.
• Lead the Physician Advisory Committee, Quality Management Committee and other associated committees.

Requirements:

• 3+ years of experience in commercial health insurance
• A minimum of five years of clinical practice experience with strong knowledge of the managed care industry, the Affordable Care Act and Medicaid
• 2+ years of quality management experience
• Completion of an accredited medical degree program (Medical Doctor or Doctor of Osteopathic Medicine)
• Familiarity with current medical issues and practices

Job Tags

Local area,

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