The Chief Medical Officer is responsible for the overall strategic direction and oversight of the delivery of care of the plan.
This position is responsible for quality management, utilization review, credentialing, case management and Pharmacy. Key areas of concentrations include – 1) collaborating on population management strategies, 2) disease management products and programs, 3) data base development and outcomes research, including development, implementation, market research and 4) strategic partnerships.
This position is the ultimate medical policy decision maker for the corporation.
ESSENTIAL FUNCTIONS:
Develop and implement the strategic plan for medical management population management, outcomes analysis, case management and population management.
Senior Executive level responsibility for direction and oversight of Medical Operation and staff (Quality, Utilization, Credentialing).
Develop and implement new medical management initiatives and programs.
Develop and maintain relationships with academic institutions for the purposes of business and research collaboration.
Identify and assess managed care entities for potential business alliances.
Participate in executive strategic planning at the corporate level.
Serves as Chair of the Quality Improvement, Utilization management, Credentialing and Peer Review Pharmacy and Therapeutics Committee.
Interacts with provider when discussion will assist in resolving quality or utilization issues.
Monitor company compliance with government and contractual compliance including DMHC, CMS, DHCS and other agencies.
Evaluates provider profile data reports, provides consultation, and recommends intervention, including disciplinary action per policy/ procedure.
Oversee the utilization management guidelines and decisions.
Support sales and marketing through presentation to key decision makers in clients and prospects
Support corporate counsel in risk management and contract evaluation.
MINIMUM POSITION REQUIREMENTS:
Five years of experience in a health plan, medical group or IPA or quality management administrative position.
Three years of experience in developing and maintaining administrative claims data set for the purposes of outcomes analysis and outcomes management.
Working knowledge of statistics
EDUCATION:
A medical degree, either a M.D. or a D.O.
Board certified in a specialty.
Internal Number: SEA000090
About Seaside Health Plan
Let us introduce ourselves. We're MemorialCare, a nonprofit health system that includes four hospitals, two medical groups, imaging centers, surgical centers and much more. As one of the leading health systems in Orange County and Los Angeles County, we're confident that no matter what your needs are, we have the teams, tools and know-how to support you every step of the way.
