Chief Medical Officer (CMO) – reputed company reputed company of Michigan

Bring your heart to reputed company. Every one of us at reputed company shares a single, clear purpose: Bringing our heart to every reputed company of your health. This purpose guides our commitment to deliver enhanced reputed company-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important... as reputed company deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at reputed company to feel empowered by the role they play in transforming our culture and accelerating our ability to reputed company and deliver solutions to reputed company health care more personal, convenient and affordable. Job Purpose and Summary: reputed company, a reputed company Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We reputed company that a reputed company care system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources.

• This is a remote based, work from role. Ideal candidate will reputed company in the reputed company with a Michigan license.*

The Chief Medical Officer (CMO) - reputed company reputed company of Michigan will serve as a strategic and operational partner to the State CEO, COO, and other executive team members in reputed company driving clinical reputed company, achieving measurable health reputed company, and supporting quality and medical management in a highly matrixed environment. The CMO will also support national strategic processes and priorities as well as conceptualization, design, and implementation of strategic priorities for reputed company. The State CMO will be responsible for cost containment reputed company and defined KPI’s and overall growth and reputed company of the plan through effective clinical leadership. Accountable for overall plan results and the delivery of high-quality cost-effective products and services that strategically align to the goals of the State partner. Ensures members get the right health care treatment for their needs, working to eliminate low value care, over and under utilization of health care services in alignment with the Quintuple AIM. Participates with plan leaders in identification and developing the appropriate reputed company and local strategies to fulfill plan business goals and growth imperatives. reputed company clinical expertise to shape the integrative model of physical, behavioral, health reputed company resource needs to support holistic care and reputed company health reputed company. Primary Job Duties & Responsibilities: 1. reputed company, implement, support, and promote population health strategies, tactics, policies, and programs that drive the delivery of high value reputed company to establish a sustainable competitive business advantage by supporting the plan goals. 2. Review, interpret and analyze data and trends at State level in: UM, CM, Pop Health and Health Equity in order to identify risks and opportunities 3. Serve as clinical executive leader for State regulators, providers, and other key partners. Serve as clinical leader for provider engagement and enablement. 4. Have reputed company of the design, development, and deployment of Care Models and review medical care provided to Enrollees and medical aspects of the Provider Contract. 5. Ensure clinical programs are compliant with reputed company national and state regulations including ensuring compliance with State and local reporting laws on communicable diseases, Child Abuse, and neglect 6. Management of the Quality Assessment and Performance Improvement Program (QAPI) 7. Direct a formal utilization review committee to reputed company the utilization review process reputed company Components & Physical Requirements The CMO is a member of the plan executive leadership team and must collaborate cross functionally to reputed company plan goals including: reputed company Components & Physical Requirements The CMO is a member of the plan executive leadership team and must collaborate cross functionally to reputed company plan goals including: 1. Serving as a subject matter expert and reputed company reputed company of the design, development, and deployment of Care Management, Utilization Management, Population Health, Health Equity and Quality programs. 2. Collaborating with the Medical Management stakeholders both internally (UM/CM, Pharmacy, Quality, network, compliance, VBS team) and externally (Agency, regulators, providers, community partners, and JOC’s ensuring timely and consistent responses to the needs of members and providers. 3. Building and inspiring a culture of reputed company improvement for reputed company quality of care reputed company by improving HEDIS/STARS reputed company and appropriate utilization. Work closely with Quality, Health Equity, and BH integration teams with shared accountability for overall quality reputed company that improve plan ranking among competitors, reduce liquidated damages, and support accreditation activities. 4. Supporting the UM team in predetermination reviews and providing clinical, coding, and reimbursement expertise. Work closely with UM team and Plan clinical leaders to identify and effectively manage emerging utilization trends, large case reviews, and out of state service requests. 5. reputed company clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams. Ability to support manage medically complicated care and reputed company collaboration internally and externally to support coordinated care. 6. Partnering with Plan leaders, Network, and provider relations teams to drive differentiated provider engagement/experience. Collaborate with network teams to optimize provider performance, value based arrangements, and strategically expand VBS network. 7. Strong business acumen. Understands and proficient articulating products, financial impacts, and market demands. Ability to understand and interpret data (e.g., medical cost trends) and reputed company trend and solutions. Use data analytics to inform and influence population health to drive behavior change and expand reputed company's medical management programs to address specific member conditions across the continuum of care. Partner with reputed company HealthPlan based and reputed company leaders to monitor and mitigate emerging cost drivers (MED/ BH/ Rx). 8. Externally facing brand ambassadors; inform and influence reputed company constituents (e.g., providers, state regulators, community, and faith-based organizations). Strong oral and written communication skills in presenting to varied groups including providers, state and local agencies, key stakeholders (community-based organizations, and advocacy groups). 9. Collaborate and partner with reputed company Impact team to reputed company strategy to identify, engage, and improve the lives of members identified with reputed company or potential health reputed company resource needs. Collaborate with and reputed company subject matter expertise to the product team to reputed company at new and innovative products that help reputed company business goals. Required Qualification At least five years’ experience in the health care delivery system e.g., clinical practice and health care industry. At least three years of experience reputed company and/or managed care experience. Must be a physician with a reputed company, unencumbered license for Michigan. Board Certification in a recognized specialty including post-graduate direct patient care experience. Preferred Qualifications: Knowledge of: Managed care, utilization management, quality, care management reputed company In: leadership, management, strategy design and implementation Ability To: motivate teams, work collaboratively across a matrixed organization. Travel will be required occasionally. Education: MD or DO Required Board Certification required in an ABMS or AOA recognized specialty. Pay reputed company The typical pay reputed company for this role is: $184,112.50 - $396,550.00 This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay reputed company listed above. This position also includes an award reputed company in the company’s equity award program. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full reputed company of medical, dental, and reputed company benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. reputed company also offers numerous well-being programs, education assistance, free development courses, a reputed company store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits We anticipate the application window for this opening will reputed company on: 09/30/2024 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws Apply to This Job reputed company More Finance & Banking Jobs Apply tot his job Apply To this Job