VP, Chief Medical Officer, Medicare

Your Role

The VP, CMO, Medicare is accountable for providing medical oversight, expertise and leadership to ensure the delivery of affordable, quality healthcare services across all Medicare product lines (Individual, Group, PPO). The role requires strong partnerships with the General Manager of the Medicare team, the Quality team, the Encounter team, and Network Management and as applicable other cross-functional leaders/team who impact Medicare performance, and will require a deep connection and "oversight" of the UM and CM teams within BSC. In addition, the work can only be successful in close collaboration with the delivery system partners who are delegated for certain clinical and administrative functions. As such, the VP CMO, Medicare will need to have strong skills in influencing, leading by example to establish, maintain and support provider partnerships, with insights and experiences in both health plan and delivery system infrastructure.

The VP CMO, Medicare will think strategically, have strong leadership and management skills, and be distinguished for the ability to achieve results and quality outcomes. The ideal candidate will have a successful track record of clinical oversight and outcome based performance, understand critical components of accurate and timely submission of risk scores through encounter data, Medicare revenue and costs related to utilization management, case management, pharmacy management, Medicare Stars experience, general health plan knowledge and firsthand experience implementing clinical programs into delivery systems, and facilitation of good working relationships and management of IPA's, medical groups and integrated health systems.

Your Knowledge and Experience

• Medical degree (M.D./D.O.)
• Completed residency preferably in adult based primary care specialty (e.g. internal medicine, family practice)
• Active, unrestricted California State Medical License
• Minimum of 12 years of relevant experience required; including a minimum of 5 years managed care experience, and 5 years leading and managing staff
• Prior health plan experience, specifically as a Regional Medical Director
• Experience with Medicare Stars program (HEDIS, HOS, CAHPS)
• Experience with the Delegated Model
• IPA/Medical Group experience with >100,000 enrollees, including roles to influence practice change and to implement clinical intervention
• Clinical work in Internal Medicine, Family Practice, Pediatrics or emergency Medicine
• Understanding of the California marketplace
• Understanding of Accountable Care Organizations, and experience working in them
• Excellent verbal, written, presentation and group facilitation skills required, with the ability to convey complex or technical information in a manner that others can understand at all levels of the organization.
• Proven ability to develop and lead high performing teams
• Strong critical thinking skills required