15 days old

Chief Medical Officer

Wellmark
Des Moines, IA 50309

Job Summary<\/h2>

***Please note that Wellmark is leveraging an Executive Search Partner for this role. Any information you provide may be shared with this firm as part of our assessment process***<\/strong><\/p>

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The Chief Medical Officer (CMO) will organize and direct the delivery of all required healthcare management, clinical services, and quality management programs to Wellmark members to improve the quality, effectiveness, and the overall cost of care.<\/p>

Working closely with the Wellmark leadership team, this individual will become familiar with the established vision, mission, and strategies of the organization, and will then build on these in order to effectively define, articulate, and address current and future needs of Wellmark. This will include ensuring that the approach to program development is patient-centered while maximizing cost containment and performance optimization.<\/p>

The ideal candidate will have a reputation for being a strong business leader and will have a track record of achieving measurable goals. The CMO is responsible for leading all clinical initiatives for Wellmark, including clinical strategy, clinical quality in the provider network, policy formulation and administration, as well as operational oversight of health services to include quality, utilization, case and condition/population health management functions. The CMO will be motivated to continually develop and drive innovative strategies that focus on improving health and managing costs for Wellmarks membership. The candidate will be able to plan and implement a future state in which Wellmark members are dynamically identified and stratified for the purpose of care teams to engage members in their use and navigation of the healthcare system. This new, integrated model will result in a better member experience, improved health outcomes, and lower total cost of care. The care team model will determine the future structure, staff, technology, and talent required to deliver on Wellmark objectives.<\/p>

Qualifications<\/h2>

The successful candidate will have an MD or DO degree from an accredited college of medicine, and in compliance with appropriate continuing education requirements, Board Certification in a specialty recognized by the American Board of Medical Specialties with a preference for internal medicine or primary care specialty. This leader must meet licensing and credentialing standards for physician providers to Wellmark. The chosen executive will be licensed as a physician in the state of Iowa or South Dakota or have the ability to obtain a license. In addition, the candidate will have at least five years of experience in direct clinical practice beyond post-graduate training. An advanced degree in health services administration, public health, or business administration (MHSA, MHA, MPH, or MBA) is highly preferred.<\/p>

The successful candidate will have at least 10 years of progressive experience and responsibility at a senior administrative leadership level in managed healthcare. The candidate should have a demonstrated track record of success in managing the inner workings of health services activities, including case management, utilization management, population health, quality management, and payment policy. Prior leadership experience in a hospital, clinical, or integrated delivery system is also very helpful.<\/p>

Specifically, it is important the successful candidate have a thorough knowledge of the following areas:<\/p>

\u2022 Extensive experience and understanding of managed care operations with a proven track record of healthcare services operations to include care management, utilization review, quality management, and measurement of clinical outcomes. Complete understanding of Medical Loss Ratio (MLR) cost drivers and demonstrated success in reducing the MLR.<\/p>

\u2022 Demonstrated success in designing, implementing, and operating programs that measure and positively increase quality while reducing costs.<\/p>

\u2022 Keen awareness of physician/provider payment issues, physician practice models, and total cost of care and quality improvement methodologies. Experience applying innovative and creative approaches to improve healthcare delivery.<\/p>

\u2022 Successful track record in hiring and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; and addressing and resolving problems.<\/p>

\u2022 Strategic thinking and long-range planning skills with the ability to design, execute, and link multiple projects over time to achieve future strategic goals.<\/p>

\u2022 Strong written and verbal presentation skills with the ability to make technical issues understandable. Effectively present information to top management, staff, public groups, and board of directors.<\/p>

\u2022 Experience and demonstrated skill in leadership of physicians and health professionals.<\/p>

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\u2022 Demonstrate superb domain knowledge and be conversant with interpretation and application of data and analysis at the highest level and broadest scope. Possess superior analytical skills.<\/p>

JOB ACCOUNTABILITIES<\/h2>

\u2022 Provide leadership and vision for the overall strategic development and execution of Wellmarks health services strategy, which drive overall health services priorities, policies, and initiatives to manage healthcare utilization and costs, improve the quality of care, and improve the health status of members. This includes medical policies and affairs, care management, quality improvement, accreditation, condition support and population health management, grievances and appeals, and behavioral health.<\/p>

\u2022 Provide leadership and direction in the assessment, development, and implementation of the strategic plans and goals for improving member health status and quality of care, achieving budgeted loss ratios, and eliminating waste. Provide analysis and recommendations to the leadership team regarding trends and potential solutions to positively impact clinical quality and medical costs and help establish benchmarks and targets.<\/p>

\u2022 Develop and implement policies and programs which support, promote, and advance the delivery of high-quality care consistent with evidence-based standards that address the unique needs of members by line of business.<\/p>

\u2022 Analyze and interpret claims and clinical data relative to utilization management, quality, and clinical programs to meet and exceed organizational goals and to ensure \u201cearly warning\u201d processes and proactive interventions are in place. Specifically, develop, implement, and manage clinical programs for Wellmark members with heightened emphasis on addressing the needs of high-risk members.<\/p>

\u2022 Provide clinical leadership for the ongoing development, implementation, and management of information systems and data analysis for quality, utilization, and clinical performance measurement, ensuring the continued evolution of medical informatics platforms to meet business and customer reporting needs.<\/p>

\u2022 Ensure an awareness of change in the healthcare industry, policy evolution and advocacy on public health matters, advancements in clinical research and treatment/practice patterns, and emerging therapies for the benefit of Wellmarks members with respect to benefits, coverage, and payment determinations. Understand and apply national, regional, and state/local trends in healthcare delivery and managed care to positively influence members/customers.<\/p>

\u2022 Work collaboratively with the Vice President of Health Services and Vice President Chief Pharmacy Officer to develop robust, integrated, and market leading case, condition, and utilization management programs with demonstrated return on investments in health improvement and total cost containment.<\/p>

\u2022 Ensure efficient operations and optimize business processes to reduce cycle times and administrative costs with the goal of improving member experiences and provider transactions.<\/p>

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\u2022 Collaborate with commercial markets and future Medicare programs to create a market-leading value proposition and competitive sales advantage for Wellmark by articulating and delivering innovative approaches to health improvement, health management programs, and quality improvement. Actively support Wellmarks sales and marketing activities, including development and presentation of the Wellmark quality/value proposition. Participate in RFPs, RFIs, and sales visits as appropriate.<\/p>

\u2022 Working closely with health network leadership, help align provider performance incentives and assist with network development and value-based payment activities. As needed, provide medical input and peer support with respect to payment policies, healthcare affordability, provider partnerships, provider communications, and network development activities. Identify opportunities to strengthen physician, hospital, and other provider relationships.<\/p>

\u2022 Provide leadership and direction to the Chief Pharmacy Officer to ensure programs meet the needs of the membership while remaining competitive in the market. Work in conjunction with the Chief Pharmacy Officer to oversee the pharmacy program in formulary development, benefit design, and maintenance of benefit plans.<\/p>

\u2022 Develop and foster strong working relationships and communication at all levels of the company to ensure timely implementation of new strategies.<\/p>

\u2022 Collaborate with human resources to attract, retain, and develop a high performing management team. Establish annual performance goals and development plans for all direct reports and their respective teams. Monitor progress on a regular basis to ensure that engagement through the use of strengths and commensurate performance of employees is at the highest possible level.<\/p>

\u2022 Serve as a clinical spokesperson for Wellmark on health-related matters of interest and importance. As a key interface on health and benefit-related issues with providers, employers, regulators, corporate entities, prospective clients, community coalitions, and national associations, the CMO will develop and articulate a compelling message of the value of Wellmarks Health Services and Quality Management programs to advance member and public interests. Represent Wellmarks interests as necessary on clinical issues to various external constituencies, including but not limited to the states of Iowa and South Dakota, CMS and other governmental agencies, medical and hospital communities, and various advocacy organizations. Provide leadership in building community partnerships that serve Wellmarks mission.<\/p>

\u2022 Establish and oversee appropriate professional standards of participation for all providers via the credentialing process and by monitoring quality of care, member complaints, and potential instances of fraud, waste, and abuse. Also work to ensure compliance with legal, regulatory, and accreditation standards with respect to all utilization medical and quality matters.<\/p>

\u2022 Oversee and monitor applicable clinical vendors and subcontractors, ensuring their performance meets or exceeds the established guidelines of the organization.<\/p>

\u2022 Other duties as assigned.<\/p>

Categories

Posted: 2020-05-21 Expires: 2020-06-20

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Chief Medical Officer

Wellmark
Des Moines, IA 50309

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