VP Medical Affairs/CMO Job in Albuquerque 87101, New Mexico US

VP MEDICAL AFFAIRS/CHIEF MEDICAL OFFICER

POSITION SUMMARY
Responsible for clinical responsibilities, medical management systems, reporting, workflow processes, clinical decision making, policies and procedures. Also responsible for collaborating to implement new and improve existing disease and care management programs and integrates services across the health plan’s service and delivery systems to ensure the best possible quality care for members. Responsible for the direct oversight and success of the quality program to include the Quality Committee and its subcommittees, NCQA accreditation and delegated vendor activities, utilization management programs and controls, complex case and disease management, credentialing activities, medical cost reduction initiatives. Direct reporting relationship to the Plan President and the EVP of Corporate Medical Affairs/Chief Medical Officer concerning the clinical and technical aspects of that position.  Assists the Plan President in strategic planning and providing input and recommendations to the various functions and activities within the organization that impact the delivery of medical care.  Participates actively in health plan committees and programs to achieve plan and corporate goals.
 

ESSENTIAL FUNCTIONS
Duties and Responsibilities
• Provide leadership to the health plan in the areas of strategic planning, strategy execution and implementation of care management programs, including such programs as Quality Improvement, Utilization Management, Care Management, Predictive Modeling, and Disease Management
• Supply leadership to the health plan in regards to the analysis of medical care cost and utilization data.  Leads and manages the development of techniques to effectively correct identified and anticipated utilization problems while assuring that our members receive the care they need
• Provide leadership, direction and oversight functions to the health plan’s  medical management staff designed to achieve best in class performance as defined by identified metrics
• Offer a positive leadership role in key health plan medical management initiatives aimed at optimizing utilization of medical resources
• Oversee, direct and support the rendering of medical management decisions at all levels of the health plan that maximize benefits for our members while pursuing and supporting corporate objectives
• Support quality improvement programs at all levels of the health plan (e.g., Disease Management, Care Management, Provider Profiling) and ensures that medical policies and procedures are implemented to comply with regulatory and accreditation agencies such as NCQA, CMS, and DHS
• Present a team environment that is results oriented but also recognizes the individual contribution
• Give input and feedback on how contracting operations, claims, and benefit design impacts medical management programs by collaborating with provider network, contracting, claims, operations, and other Molina associates, as appropriate
• Represent Molina in public forums
• Initiate and participate in provider educational and contracting meetings as needed
• Other duties as assigned

Knowledge, Skills and Abilities
• Excellent working knowledge of varied managed care marketplaces
• Self starter. Innovative. Dependable and hard working.
• Effective one on one and group interrelationship skills.
• Ability to be flexible and adapt quickly to the changing needs of the organization.
• Ability to quickly learn new skills and apply them successfully.
• Ability to successfully balance the demands of multiple tasks.
• Ability to effectively sort through the complex maze of data and principles to commit to and own the final process/outcome.
• Excellent verbal and written communication skills
• Ability to abide by Molina’s policies
• Maintain regular attendance based on agreed-upon schedule
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers

QUALIFICATIONS

Required Education 
• MD with unrestricted current Missouri medical license
• Board Certification in a recognized medical specialty
• Masters degree in business or related equivalent with certification/experience 

Required Experience     
• Extensive managed care experience in working with primary care, specialty physicians and medical facilities on medical management issues
• Minimum  5 years of Clinical Practice
• 5+ years of managed care administrative experience to include NCQA or URAC
• Experience with physicians practicing in groups, IPAs or individually
• Exposure to or experience with Government sponsored product lines
• Experienced in media relations

Molina Healthcare is an Equal Opportunity Employer M/F/D/V.