C&S Plan of Kentucky - Chief Medical Officer

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** Caring. Connecting. Growing together*
* The Community & State Plan of Kentucky Chief Medical Officer (CMO) will use their proven track record to become the end-to-end owner of the clinical, quality and value-based provider leadership and financial outcomes. The position has accountability for all health plan product clinical product offerings, clinical market strategies, collaboration and oversight of our Shared Services clinical team, clinical data analysis to improve clinical and cost outcomes, new clinical program implementations, monitoring and valuing clinical outcomes and operational performance, driving affordability pipeline and performance, overseeing development and implementation of initiatives to meet quality standards, ensuring compliance with state Medicaid compliance standards-where applicable, and value based initiatives through clinical and vendor organizations.  

The Kentucky CMO is also responsible for the clinical relationships with our state client and key clinical leaders across the Commonwealth of Kentucky.

** Major*
* ** Responsibilities*
* 1.
Clinical Quality and Operational Performance
- Oversight of clinical processes and policy decisions with a focus on implementing plans of care that meet accepted guidelines and protocols to ensure that optimal and appropriate medical/ clinical are provided in a cost-effective manner.

2.
Strategic Clinical Leadership and Innovation
- Development, implementation, and oversight of the population health strategy

3.
Serves as chairman of the Health Plan's Quality Improvement Committee (QIC)

4.
Financial oversight
- Drive improved affordability related to medical and pharmacy spend for lower TCOC, greater capture of state level quality-based incentive dollars, and improved provider diagnosis, documentation and capture of member chronic conditions

5.  Ensure services are delivered to members at the highest quality standards. Oversee and ensure development and implementation of initiatives to meet or exceed HEDIS quality standards, and accreditation standards through working with and holding Quality Shared Services accountable.

6.
Develop strong collaborative partnerships across a highly complex and matrixed organization including key partnerships with the local Market leadership team, functional VPs, Market CMOs, health plan CEOs and Executive Directors across all lines of business (Commercial, Medicare, Medicaid)

7.  Continuously improve HEDIS, and CAHPS scores for members and providers

8.
Provide guidance and direction to physicians and nurses regarding all aspects of medical care and multi- level transitions of care including the referral process as well as any quality-of-care concern and related plans of correction

9.
Review inpatient cases where applicable for successful bed-day management that meets established company goals

10.
Analyze utilization data to identify trends and opportunities for process improvement related to medical    treatment (inpatient and outpatient)

11.
Serve as clinical subject matter expert for needs assessment, design, implementation, and evaluation of clinical programs to support continued growth and affordability of the Health Plan

12.
State and Community Advocacy
- Cultivate and sustain strong relationships across stakeholders to influence program design, develop support for program efforts, secure approvals and foster collaborative partnerships.

13.
Participate in senior medical management strategy development and implementation to ensure that appropriate care and services provided to members meet best practice standards as well as regulatory compliance requirements and Internal Quality Assurance Program

14.
Educate physicians and nurses in effective management of Health Plan benefits and medical services that meet the needs of the members and utilizes resources appropriately

15.
Oversee the development and revision of the Health Plan's clinical care standards and practice guidelines and protocols

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

*
* Required Qualifications:

*
* + Active/unrestricted Kentucky M.D/D.O. License

+ Active Board Certification

+ Kentucky Resident or willing to relocate to Kentucky

+ 5+ years of direct patient facing clinical work

+ 5+ years of progressively responsible management experience, in a managed care setting or large health-system/clinically integrated network population health leadership

+ Broad and comprehensive knowledge of medical management principles and insurance products…