We are currently in search of a seasoned healthcare management professional for the role of Chief Medical Officer for a health plan. This position is located in the Chicago suburbs.
As the Strategic Clinical Leader, this executive will provide clinical expertise and business direction in support of health management programs to promote the delivery of high quality, consumer-centric medical care. This Chief Medical Officer will provide critical medical and business leadership both with internal and external clients and strategic partners.
NOTE: MUST HAVE HEALTH PLAN OR TPA EXPERIENCE
The Chief Medical Officer will provide guidance for all clinical operations and is responsible for oversight of clinical decision-making aspects of the organization. S/he will meet the organizational objective to have qualified clinicians accountable to the organization for decisions affecting consumers and will develop and manage ongoing activities of the infrastructure as required by accrediting organizations.
Additional responsibilities include:
Act as lead business and clinical thought leader to determine the company’s clinical strategy, use of analytics in health care management and network strategies with providers and facilities to support improved health and provide top-quartile medical management results for clients.
Provide clinical guidance in the design and operation of effective health programs to promote member quality of care and in reviewing potential lapses in the quality of care.
Provide oversight, leadership and direction for the healthcare management functions led by the clinical teams to include:
Participating in quality management activities at regional and market levels including those necessary to achieve/maintain NCQA and URAC accreditation
Proactively use data analysis, predictive modeling and medical cost forecasting capabilities to identify opportunities for quality improvements and to positively influence the cost-effective delivery of quality care.
Work collaboratively with the executive team and the regional leaders that interface with medical management including clinical operations, provider contract management, client and partner contracting, member services, sales, benefits and claims management, product & marketing in order to achieve the company’s business goals.
Lead clinical staff in assuring members' care is coordinated in a fashion that achieves the most value for the available benefits and that an advocate is available to the member and their caregiver for coordination of benefits.
Provide clinical expertise and business direction in support of health management programs through participation in clinical team activities in the execution of precertification, concurrent review/discharge planning, appeals, case management, disease management, and quality management. This includes direct participation with plan sponsors, providers, facilities and vendors as required.
Partner with medical management leadership to increase the effectiveness of medical management programs and to promote the use and integration of other vendor partner medical programs.
NOTE: MUST HAVE HEALTH PLAN OR TPA EXPERIENCE
The Chief Medical Officer will have expert knowledge of medical benefits management, quality initiatives, pharmacy utilization review, managed care, contracting, negotiation and relationship building. A Board-certified physician with a strong knowledge of healthcare and project management and TQM or equivalent quality management programs is required. This individual will have a strong customer focus, interpersonal skills that allow for harmonious relationships with providers, members and co-workers, and management skills in an operationally changing environment with drive for results and success based on planned objectives. S/he will recognize strategic opportunities and use data to make timely and sound decisions and will be flexible and willing to adjust to shifting demands and priorities. We are looking for a leader with the ability and experience to assimilate multiple new functions, services, projects and systems while maintaining existing systems and programs. S/he will have demonstrated appreciation of cultural diversity and a sensitivity towards target populations. The individual will have management experience as well as clinical experience and experience in healthcare delivery system, e.g., clinical practice and health care industry. This executive will have a proven record of driving results that meet or exceed strategic, financial, quality and operational goals. The right leader will have high standards of performance while pursuing aggressive goals and be a principled leader with sound business ethics.
Additional skills required:
Excellent communication skills; oral, written, and analytical.
Ability to collaborate across various functions.
Ability to comfortably and clearly communicate complex information to varied audiences.
Experience working in or with large employers and corporate health programs.
Experience leading teams of highly skilled analytical professionals.
Familiarity with medical management platforms.
Belief in the use of evidence-based medicine.
Comfortable/experience with public speaking – to a variety of stakeholders with variable knowledge of healthcare.
Additional Salary Information: An attractive compensation package comprised of base salary, annual and long-term performance bonuses and comprehensive benefits will be provided to the selected candidate.
Internal Number: 1
About Korn Ferry
Korn Ferry is a global organizational consulting firm We work with clients to design their organizational structures, roles and responsibilities. We help them hire the right people and advise them on how to reward, develop and motivate their workforce. And, we help professionals navigate and advance their careers.