Job Description
Are you a passionate and experienced physician leader with a focus on behavioral health? We're seeking a dynamic Senior Medical Director to serve as our Chief Medical Officer for our health plan in New Mexico. This is a fantastic opportunity to shape the future of healthcare delivery, improve lives, and lead a dedicated team. This is a remote position within New Mexico.
What We Offer:
Competitive Compensation: We offer a generous salary range that reflects the importance of this leadership role. Actual pay will be adjusted based on your skills, experience, education, and other job-related factors.
Comprehensive Benefits: We provide a comprehensive benefits package designed to support your well-being, including health, life, voluntary, and other benefits and perks.
Opportunity to Lead: This is a high-impact role where you will have the opportunity to develop and implement clinical strategies across all lines of business (Medicaid, Medicare, and Commercial).
Make a Difference: You'll be making a tangible difference in the lives of our members by ensuring access to high-quality, cost-effective care.
Collaborative Environment: You will work alongside a talented team of professionals dedicated to improving healthcare.
What You'll Do:
Provide clinical leadership and oversight for all aspects of the health plan's clinical operations, including service coordination, utilization management, care/case management, population health/disease management, cost of care, health promotion, and quality improvement.
Lead parity efforts and maintain all required documentation and updates.
Ensure compliance with medical policies, clinical guidelines, and quality and clinical operations policies.
Analyze utilization, quality, and financial data to drive improvements in care delivery.
Oversee and mentor Medical Directors and Physician Advisors.
Build and maintain strong relationships with providers, health plan partners, members, and state agencies.
Represent the organization in the community and with key stakeholders.
Provide clinical leadership to the interdisciplinary Medical Management team, including oversight of clinical team members and consultation with care managers.
Ensure the quality of utilization review determinations, including appeals.
Review cases, make medical necessity determinations, and conduct peer-to-peer reviews.
Monitor case management and disease management programs.
Participate in case rounds and develop case management plans.
Evaluate the effectiveness and cost of care of clinical programs.
Interface with external stakeholders, including health plan and state government partners.
Provide medical leadership for Quality Improvement (QI) Programs.
Participate in network credentialing and quality improvement committees.
Recruit, train, supervise, mentor, and evaluate medical staff and physician advisors.
Develop and manage budgets.
Develop and implement Medical Action Plans (MAPs).
Implement medical policies and procedures.
Assess technology and clinical practice standards.
Monitor the quality and quantity of clinical reviews and care plans.
Collaborate with the network management team.
Provide after-hours coverage as required.
Participate in RFP response development.
What You'll Need:
Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree or equivalent international degree.
Completion of a US-based internship and residency (and fellowship for subspecialists).
At least 7 years of post-residency experience with substantial direct patient care.
Clinical experience relevant to the patient populations being managed.
Unrestricted, current, and valid medical license in New Mexico.
Board certification (ABMS or Specialty Board).
Strong leadership skills and the ability to drive change.
Experience with cost-benefit analysis, medical decision analysis, credentialing, quality assurance, and continuous quality improvement.
Targeted specialties: Psychiatry, Psychiatric sub-specialty, Primary Care, Geriatrics, Palliative Care, or Physical Medicine.
Employment Type: Full-Time
Salary: $ 222,380.00 Per Year
Job Tags
Full time, Internship, Remote work,