Job Description
We are seeking an experienced and compassionate Senior Medical Director (CMO) for Behavioral Health to provide clinical leadership and strategic direction in our New Mexico health plan operations. This fully remote position offers the flexibility of working from home within New Mexico. Candidates must hold a valid medical license in the state and have a passion for improving patient care and outcomes across diverse health plan offerings, including Medicaid, Medicare, and Commercial lines of business.
As the Senior Medical Director, you will play a crucial role in shaping and implementing clinical programs, ensuring quality care, cost-effective services, and fostering collaboration among providers, health plan partners, and members. Your leadership will help drive improvements in clinical quality, service delivery, and operational performance while meeting regulatory and compliance standards.
Key Responsibilities:
Lead the clinical vision for all lines of business (Medicaid, Medicare, and Commercial) by overseeing service coordination, utilization management, care management, population health, quality improvement programs, and medical action plans.
Analyze utilization, quality, and financial data to ensure high-quality and cost-effective care delivery.
Provide clinical leadership to an interdisciplinary Medical Management team, ensuring clinical and medical oversight of team members and offering consultation to care managers focused on cost and quality.
Oversee medical policies, clinical guidelines, and ensure compliance with NCQA and URAC standards.
Lead the development of strategies to improve healthcare quality, reduce costs, and improve patient satisfaction through comprehensive care management programs.
Develop and sustain strong relationships with providers, health plan partners, state agencies, and members, while promoting clinical excellence in the community.
Lead efforts to ensure compliance with case management, disease management, and clinical goals, monitoring program performance regularly.
Collaborate with external stakeholders, including health plan and state government partners, delivering presentations and attending meetings to discuss issues, improvement metrics, and strategic plans.
Provide leadership and oversight for Quality Improvement (QI) Programs, network development, medical practice standards, clinical appeals, and monitoring effectiveness and compliance.
Supervise, mentor, and evaluate the medical staff and physician advisors, ensuring quality care and adequate physician resources.
Develop and implement a Medical Action Plan (MAP) to address cost-effective care for all health plans, including metrics for utilization and quality management.
Oversee medical policies and clinical guidelines, providing input on modifications and supporting decision-making for clinical practices.
Monitor quality and quantity of clinical reviews and care plans, collaborating with network management teams on integrated clinical-network approaches.
Qualifications:
Required:
Doctor of Medicine (MD), Doctor of Osteopathic Medicine (DO), or Bachelor of Medicine, Bachelor of Surgery (MBBS) international degree with completion of U.S.-based internship and residency (and fellowship for subspecialists).
A valid and unrestricted medical license to practice in New Mexico.
At least 7 years of post-residency experience in direct patient care.
Experience in patient care for the populations served (behavioral health, psychiatry, geriatric care, etc.).
Board-certified in relevant specialty (BC/BE).
Preferred:
Specialties in Psychiatry, Primary Care, Geriatrics, Palliative Care, or Physical Medicine.
Experience with quality assurance, cost-benefit analysis, credentialing, and continuous quality improvement (CQI).
Why Join Us?
This leadership role offers the opportunity to shape clinical outcomes and work collaboratively with a diverse team to improve healthcare delivery. You will be part of a mission-driven organization that values patient care, innovation, and continuous improvement. Additionally, you will enjoy a competitive salary, incentives, and a comprehensive benefits package designed to enhance your physical, mental, emotional, and financial well-being.
Application Instructions:
If you meet the qualifications and are excited about contributing to the future of healthcare, we encourage you to apply. We are an Equal Opportunity Employer and a Tobacco-free workplace.
Employment Type: Full-Time
Salary: $ 222,000.00 423,000.00 Per Year
Job Tags
Full time, Internship, Remote work, Work from home,