Job Description
Are you a passionate and experienced physician leader ready to make a real difference in behavioral health? We're seeking a dynamic and compassionate Chief Medical Officer to lead our clinical vision and drive impactful change in New Mexico. This is a fantastic opportunity to shape the future of healthcare delivery across Medicaid, Medicare, and Commercial lines of business, all while enjoying the flexibility of remote work within the beautiful Land of Enchantment.
What You'll Do:
As our Chief Medical Officer, you'll be the clinical compass, guiding our health plan's strategy and ensuring the highest quality of care for our members. You'll champion innovative programs focused on service coordination, utilization management, care and case management, population health, disease management, cost of care, health promotion, and quality improvement. Your leadership will be instrumental in driving parity efforts and ensuring compliance with all necessary regulations and guidelines.
Imagine analyzing data to uncover opportunities for improvement, collaborating with providers and stakeholders to build strong relationships, and promoting our commitment to clinical excellence within the community. You'll inspire and mentor a team of medical directors and physician advisors, empowering them to deliver exceptional care. This role offers the chance to truly impact lives, often requiring work outside of traditional hours and occasional travel for important meetings.
Your Key Responsibilities:
Provide clinical leadership and mentorship to the interdisciplinary Medical Management team, offering guidance and training to care managers on cost and quality of care.
Ensure the quality of utilization review determinations, including appeals, by reviewing cases, making medical necessity determinations, and conducting peer-to-peer reviews.
Monitor case management and disease management programs, ensuring alignment with clinical goals through regular performance reviews.
Participate in case rounds and the development of personalized case management plans.
Evaluate the effectiveness and cost-efficiency of clinical programs through data analysis, assisting with root cause analyses and program adjustments.
Build and maintain strong relationships with external stakeholders, including health plan partners, state government agencies, and regulators, representing our organization at meetings and presentations.
Provide medical leadership and consultation for Quality Improvement (QI) programs, overseeing effectiveness, compliance, prevention programs, network development, quality of care concerns, and clinical appeals.
Champion parity efforts by providing documentation and engaging in discussions with health plan and client leaders.
Actively participate in committees focused on network credentialing and quality improvement, leading NCQA-compliant clinical quality improvement activities.
Recruit, train, supervise, mentor, and evaluate medical staff and physician advisors, ensuring adequate physician resources and managing related budgets.
Develop and implement a Medical Action Plan to address cost of care, including metrics for utilization and quality management, and create strategies to achieve goals.
Implement national and local medical policies and procedures, providing input on necessary modifications and additions.
Assess technology and clinical practice standards, participating in inter-rater reliability processes.
Monitor the quality and quantity of clinical reviews and care plans, collaborating with the network management team on an integrated clinical-network approach.
Provide after-hours coverage as needed.
Maintain all required licenses and certifications.
Contribute to RFP response development and writing.
What You'll Bring:
Targeted specialties: Psychiatry, Psychiatric sub-specialty, Primary Care, Geriatrics, Palliative Care, or Physical Medicine.
Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree, or an equivalent international medical degree with required US-based training.
Graduation from a US or Canadian medical school accredited by the ACME, or equivalent foreign medical school training with successful completion of required US examinations.
Completion of a US or Canadian residency program approved by the ACGME.
At least 7 years of post-residency experience with substantial direct patient care.
Clinical experience relevant to the patient populations being managed.
Unrestricted, current, and valid license to practice medicine in a US state or territory.
Proven ability to lead and implement change effectively.
Experience with cost-benefit analysis, medical decision analysis, credentialing, quality assurance, and continuous quality improvement (CQI) processes.
What We Offer:
A competitive salary range reflecting your skills and experience.
A comprehensive benefits package designed to support your physical, mental, emotional, and financial well-being.
The chance to make a tangible impact on the lives of others.
A supportive and collaborative work environment.
The flexibility of remote work within New Mexico.
Employment Type: Full-Time
Salary: $ 222,380.00 Per Year
Job Tags
Full time, Local area, Remote work,