Chief Medical Officer, Regional Operations

Primary Responsibilities

• Provides clinical leadership in the development, organization and governance of a clinically integrated network (CIN) of physicians or Population Health Services Organization.

• Responsible for directing the improvement of clinical, quality, and financial outcomes for the operating partnerships.

• Provides change management expertise in health systems, provider organizations, and physician practices.

• Participates in the alignment of physician incentives, quality measures, and value-based contracts.

• Maintains strong relationships with Provider PHSO Medical Directors and clinical leaders at partnering organizations.

• Directs and monitors medical management activities and quality management programs as needed to maintain compliance with CMS, NCQA and other accrediting bodies.

• Collaborates with the Provider Engagement team to move physician offices to accountable care model.

• Collaborates with the Corporate Chief Medical Officer (CCMO) on clinical strategy, design and approach, facilitating communications, and managing risk on engagements.

• Acts as an internal consultant on clinical program development and special projects for Lumeris customers.

• Participates in ongoing product development activities related to Lumeris technologies and services.

• Provides timely communications and progress reports regarding Lumeris activities and external client status.

• Provides support to the Accountable Delivery Systems Institute as needed on matters relating to accountable care, physician engagement/alignment, payer and clinical transformation, and the use of top technology in support of the new models of care.

• Participates in business development meetings with prospective clients to present the Lumeris value proposition.

• Supports the Lumeris Advisory Services team in content development and supporting the delivery of V2Vs.

• Contributes to the Clinical thought leadership of the organization through presentations, case studies and scientific articles.

Qualifications

• MD. or D.O. degree, plus Board Certification

• Current, unrestricted medical license

• 15+ years of relevant experience or the knowledge, skills, and abilities to succeed in the role

• 7+ years of people, program, or project leadership experience or the knowledge, skills, and abilities to succeed in the role

• 5+ years of successful clinical practice experience

• 3+ years of health system, health plan or capitated provider experience with exposure to managing total cost of care, quality, and documentation and coding

• Deep understanding of population health & managed care

• Strong background in administrative clinical leadership

• Solid understanding and experience with population health management strategies  

• Knowledge of healthcare financing and the relation to various managed care products (HMO, PPO, Indemnity, and Medicare Advantage)

• Knowledge of continuous quality improvement theory and practice

• Excellent communication and problem-solving skills

• Demonstrated track record of building productive working relationships internally and externally at all levels

• Proven ability to positively impact results

Preferred

• MBA or Master's Degree in healthcare or other related field

• Prior operational consulting experience

• Government sector experience (Medicare or Medicaid products)

Working Conditions

• While performing the duties of this job, the employee works in normal office working conditions.

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