VP, Market Chief Medical Officer(Must live in Wisconsin & Open To Relocation)

Job Summary:

The Vice President, Market Chief Medical Officer has accountability for ensuring that local health plan, CareSource initiatives focusing on clinical excellence, quality improvement, appropriate inpatient and outpatient utilization, affordability, health system transformation including provider network, compliance with regulatory mandates, growth and other focused improvements are implemented and successfully managed to achieve goals. 

Essential Functions:

• Primary responsibility and accountability for Total Medical PMPM performance and targets for the health plan, achieved by close collaboration with relevant enterprise stakeholders
• Participate in hospital Joint Operations Committee meetings with prioritized providers, data sharing with physicians and physician groups on quality and efficiency improvement opportunities, completing peer to peer communications for quality of care as required, and implementing local and national Health Care Affordability Initiatives in order to achieve inpatient and outpatient utilization and affordability goals
• Provides oversight to the HEDIS and CMS Stars data collection process and local performance strategy, CAHPS improvement strategy, and drives Health Plan accreditation activities as well as quality rating improvement initiatives and other clinical interventions for the local health plan
• Responsible for achievement of goals for contractually required clinical Quality Performance Indicators and state regulator-driven pay-for-quality initiatives. 
• Oversees market peer review processes including Quality of Care and Quality of Service issues, and leads the Physician Advisory Committee (PAC), Quality Management Committee (QMC) and other associated committees.
• Effectively engage with external constituents such as consumers/members, physicians, medical and specialty societies, hospitals and hospital associations, federal/state regulators, and market-based collaboratives; act as the outward face to State regulators based upon Contract, and direction of Plan President and CareSource CMO and should provide clinical thought leadership with external entities and the state
• Lead the development of a strategy to identify clinical areas where there are disparities in health outcomes across groups, and approach to closing gaps in health outcomes; support the team in maintaining NCQA Multi-Cultural Distinction designation
• Drive quality improvement and provider incentive models through identification of appropriate practices; initial contact and target setting, and Implementation, as well as ongoing leadership during monthly JOCs. The Plan CMO is accountable for oversight of the entire clinical model (end to end) within the market, including, but not limited to, CareSource’s Accountable Care Platform, clinical practice transformation, patient-centered medical homes, accountable care organizations, creative care management programs, high-performance networks and network optimization, and consumer engagement.
• Deliver the clinical value proposition focused on quality, affordability and service, in support of growth activities of …