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Deputy Chief Medical Officer (CMO)
Department(s): Medical Management
Reports to: Chief Medical Officer (CMO)
FLSA status: Exempt
Salary Grade: W - $246,000 - $368,000
In consultation with the CMO, the Deputy Chief Medical Officer oversees the medical care delivery system, including development and implementation of strategies, programs, policies, and procedures for all medical services. The incumbent will be responsible for establishing and revising standards for evaluating providers for inclusion into CalOptima's programs and monitoring the ongoing performance of participating providers. Leads determinations of medical quality and appropriateness of medical services. Collaborates with Directors and Medical Directors in the operational oversight of the medical division, including: Quality Improvement, Medical Data Management, Utilization Management, Case Management, Population Health Management, Pharmacy Management, Long Term Care, and other medical management programs. Maintains all activities of the office of the CMO and provides continuity during the CMO's absence.
• Ensures the CalOptima mission, to provide members with access to quality health care services delivered in a cost-effective and compassionate manner.
• Participates in selection of physicians, health networks, ancillary services, and other providers to participate in CalOptima programs.
• Establishes mechanisms to ensure appropriate medical decisions on service requests and appeals.
• Serves as liaison between CalOptima and provider community.
• Oversees CalOptima's medical care delivery system, including development and implementation of policies and procedures for medical services.
• Administers the development and implementation of population health management programs.
• Recruits, develops, and retains a medical director team within the Medical Affairs department.
• Ensures ongoing development of all medical service components of CalOptima including continuous quality management/improvement, utilization review and credentialing.
• Contributes to the analysis of hospital and medical outcomes to increase effectiveness of delivery patterns for the benefit of CalOptima members. Ensures education of providers in cost-effective, high quality practice strategies.
• Other projects and duties as assigned.
Knowledge and Abilities:
• Conceptualize, develop, and implement health care delivery policies in an effective managed care system.
• Plan, organize, and direct utilization review, quality management, case management, prior authorization, and grievance activities.
• Identify with providers as a practitioner and as a medical manager, and provide effective influence and leadership.
• Establish and maintain effective interpersonal relationships with all levels of staff, other programs, agencies, and the general public.
• Provide leadership to a large staff and encourage the professional performance and development of subordinate staff.
• Knowledge of Medi-Cal and Medicare managed care including understanding of contracts and at-risk arrangements with providers.
• Strong comprehension of industry and professional standards of health care, utilization management, quality improvement and other medical management functions.
• Understanding of principles and techniques of effective human resource management, including training, evaluation, and effective utilization of staff.
• Knowledge of principles and practices of healthcare, health care systems, and medical administration.
• Understanding of required governmental and other reporting criteria (i.e., NCQA, HEDIS).
• Communicate effectively at all organizational levels and in situations requiring instructing, persuading, negotiating, consulting, and advising.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Experience & Education:
• Medical Doctor degree from a fully accredited university.
• Current, valid, unrestricted California Physician & Surgeon's License with Board certification in area of specialty required.
• 5+ years of active clinical practice experience required.
• 8+ years full time managed care administration that includes Medicare and Medi-Cal experience required.
EEO Statement: CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.
ADA/Accommodation Statement: If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. You can request reasonable accommodations with 72-hour notice by contacting Human Resources Disability Management at 657-900-1134.
Job Location: Orange, California
To apply, visit https://apptrkr.com/2342588
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