• Chief Medical Officer

    Job Locations US-RI-Smithfield
    Req No.
    2018-8660
    Department
    Executive
    Type
    Regular Full-Time
  • Overview

    As member of Neighborhood’s Executive Leadership Team, the CMO is responsible for the clinical vision of the company and, along with other senior leadership members leads corporate planning and capacity building efforts to improve organizational performance. The Chief Medical Officer ensures that revenue enhancement, expense reduction and quality and service improvement efforts of the company are effective and consistent with Neighborhood’s clinical vision. He or She leads the development of Neighborhood’s clinical programs – including quality, pharmacy, medical management, behavioral health and Health@Home, assuring program effectiveness, coherency and consistency with Neighborhood’s mission, vision and values.
    The CMO also ensures that Neighborhood’s management practices and operations address the clinical and operational realities of its members and contracted clinicians.

    Responsibilities

    • Participates as a member of the Executive Leadership team in organizational planning, goal setting and project prioritization
    • Leads strategic direction and operations of Neighborhood’s primary care practice Health@Home; Functions as Physician champion for Nurse Practitioners; conducts weekly rounding meetings; manages budget; reviews medical records in EMR and selects members for tracking and program inclusion
    • Assesses organizational capacity to meet corporate goals and institutes efforts to gain needed capacity
    • Monitors corporate performance relative to goals
    • Takes leadership roles in building and maintaining a corporate-wide culture that supports and strengthens Neighborhood’s Mission, Vision and Values
    • Provides support and guidance to Neighborhood’s Board and its Committees to help them carry out their oversight responsibilities for these functions
    • Represents Neighborhood as appropriate to local physician community, particularly Community Health Centers. Ensures internal program development is based in part on local clinical realities
    • Represents Neighborhood in the local and national clinical, public health and advocacy communities as appropriate. Exercises community leadership to develop support for Neighborhood, its clinical programs and efforts to meet the health needs of its membership
    • Ensures member access to best treatments by leading Neighborhood in identification and assessment of new, successful treatments, interventions and pharmaceuticals
    • Responsible for professional development, management and guidance of staff
    • Responsible for oversight of the Case Management Program, Quality Management Program, and Medical Review/Utilization Management Program at Neighborhood. Leads efforts to understand the clinical needs of members and the design of effective programs to respond to those needs. Assures that programs and policy incorporate  the best available clinical standards
    • Assures Neighborhood compliance with contractual, licensing and accreditation standards. Responsible for standards for provider credentialing
    • Provides oversight and guidance for the Pharmacy Program, to include development of Neighborhood Formulary, thorough and timely evaluation of requests for non-Formulary products, assuring the clinical accuracy of all Part D coverage determinations and redeterminations involving medical necessity and effective contracting and vendor relationships in support of delivery of the Pharmacy benefit to Neighborhood members
    • Oversight and guidance for Medical Expense Management activities and initiative by setting utilization assumptions for medical budget, and defining cost needs and expectations in contracting; signs off on full budget. Responsible for programmatic interventions that allow Neighborhood to meet its budgetary targets for medical expenses. Analyzes provider performance in support of financial performance; builds strategy for network development upon understanding of provider performance and member needs
    • Leads and directs the successful contracting and performance of Neighborhood’s Behavioral Health vendor. Ensures integration of behavioral health quality initiatives into Neighborhood’s programs
    • The maintenance of a separate, regular part-time clinical practice by the Chief Medical Officer is encouraged but not required
    • Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood’s Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies, and procedures as it applies to individual job duties, the department and  the Company. This position must exercise due diligence to prevent, detect, and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents.

    Qualifications

    • Physician, unrestricted license in any state within the US; no restrictions in any state; and a current license in Rhode Island
    • Primary Care Training – Board certified in Family Practice, Internal Medicine, Pediatrics or Obstetrics
    • Graduate degree in Public Health or Management preferred
    • A proven leader in the healthcare field, recently as Medical Director, including budgetary, Quality Management and supervisory experience
    • Ability to exercise influence and authority across organization as both owner and advisor
    • Experience integrating the clinical administration of behavioral health and pharmacy services into medical management in a managed care setting
    • Experience with increasing access to and quality of community-based medical services for Medical-eligible populations. Includes familiarity with barriers to health care for low-income populations
    • Organizational leadership skills – planning, priority setting and interdepartmental program implementation
    • Excellent oral, written and analytical skills
    • Experience working with plan governance; prior responsibility for medical budget development and monitoring; experience working in public and national settings
    • Comfort with and commitment to public speaking and organizational representation

    Neighborhood is an Affirmative Action and Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status or any other legally protected basis.

     

    Neighborhood is committed to ensuring individuals with disabilities and/or those who have special needs participate in the workforce and are afforded equal opportunity to apply for jobs. If you would like to contact us regarding the accessibility of our Website or need assistance completing the application process, please contact us at recruiting@nhpri.org

     

    Neighborhood is an EOE M/F/D/V and an E-Verify Employer

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