Job Summary:

Senior Vice President, Enterprise Chief Medical Officer, is responsible for providing oversight, guidance and collaborative leadership to medical affairs and enterprise and market clinical leaders.

Essential Functions:

• Provide leadership and vision for overall strategic development and execution of CareSource medical affairs strategy
• Provide leadership and direction in the assessment, development, and implementation of the strategic plans and goals for improving member health status, quality of care, achieving budgeted loss ratios, and eliminating waste
• Provide analysis and recommendations to the executive leadership team regarding trends and potential solutions to positively impact clinical quality and medical cost, and help establish benchmarks and targets
• Build and maintain relationships with key stakeholders across the organization
• Lead and support RFP/Growth and M&A activities
• Provide accountability to utilization management and medical affairs teams to establish, review, and adopt medical necessity protocols, hierarchy recommendations, and coordination to ensure inter-rater reliability (IRR)
• Responsible for adherence to established metrics for medical affairs team across the enterprise
• Ensure comprehensive budget oversight, including analysis of financial data, identification of variances, and strategic adjustments to optimize financial performance
• Consultation and recommendations for vendor partner opportunities
• Provide consultative expertise in the development of clinical programs, services and initiatives
• Provides oversight for hiring of medical directors with appropriate background and experience in serving CareSource populations
• Provide guidance, direction, leadership and review for all peers
• Provides leadership in hiring and maintaining medical staff functions to achieve accreditation, regulatory, and health plan growth needs
• Drives a culture of measureable outcomes and accountability
• Key business partner in network development support, clinical product design, strategic planning, regulatory compliance, and clinical protocols
• Provide leadership and oversight as appropriate for Quality of Care Committee
• Take an active role in state and regulatory meetings to continue to influence medical policy protocols and regulatory requirements to serve CareSource membership
• Perform any other job duties as requested

Education and Experience:

• Completion of an accredited Medical Degree program as a Medical Doctor (MD) or Doctor of Osteopathic (DO) medicine is required
• Successful completion of a residency training program, preferably in primary care is required
• Minimum of five (5) years of clinical practice experience is required
• Managed care medical review/medical director experience is required
• MBA is preferred

Competencies, Knowledge and Skills:

• Microsoft Office proficient
• Critical listening and systematic thinking skills
• Ability to maintain confidentiality and act in the company’s best interest
• Oral, written, and interpersonal communication skills
• Leadership experience and skills
• Energetic, enthusiastic, and politically astute
• Ability to act with diplomacy and sensitivity to cultural diversity
• Responsive to a changing environment
• Strategic management skills
• Decision making/problem solving skills
• Conflict resolution skills
• Successful track record of driving change and quality initiatives in addition to engagement and satisfaction of medical affairs teams
• Competency in data analysis to drive medical management performance

Licensure and Certification:

• Current, unrestricted license to practice medicine in state of practice as necessary to meet regulatory requirements is required
• Board Certification, preferably in primary care specialty is required
• Re-certification, as required by specialty board, must be maintained
• MCG Certification
• To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
• CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation range $300,000-$500,000.  CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Salary

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Energize and Inspire the Organization

• Influence Others

• Pursue Personal Excellence

• Understand the Business

 

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer, including disability and veteran status. We are committed to a diverse and inclusive work environment.