Career Center

This position will serve as the experienced physician executive to guide and advance clinical performance and transformation initiatives. This position will also serve as the medical director responsible for providing medical input in the clinical decision-making processes. Critical to the success, the Chief Medical Officer will exhibit leadership qualities and clinical expertise to execute CCC business model and provide input to the administrative policy.

Specific Responsibilities

• Lead clinical leadership within medical management programs through participation in clinical team activities in the execution of prior authorization, concurrent review/discharge planning, case management, disease management, high risk care management, quality improvement and assurance, and clinical claim review.
• Provide clinical guidance in operating effective medical programs to promote member quality of care and in reviewing potential lapses in the quality of care.
• Advance clinical transformation by utilizing a thorough understanding of all aspects of managed care including value-based payments, risk arrangements, capitation, peer review, performance profiling, outcome management, care coordination, pharmacy management, and patient centered medical home concepts.
• Develop clinical quality programs utilizing broad based knowledge of population health.
• Assist with health care delivery for the health plan membership and manages the costs associated with the provision of covered services to that membership.
• Lead multidisciplinary teams across the organization focusing on teamwork, collaboration, shared success and the ability to tolerate uncertainty.
• Participate in Executive Leadership Team meetings and collaborates effectively with the members of the team.
• Work with the Director of Clinical Operations, Director of Pharmacy, Director of Dental Services, Director of Quality and Health Equity and clinical staff to address quality, cost effective care on behalf of members using available benefits.
• Educate network providers regarding organizational goals and values including but not limited to sharing relevant data, dissemination of clinical practice guidelines, recommendation of best practices, and peer to peer conversations.
• Promote managed care systems using evidence-based medicine to educate and facilitate best practices with care management staff and medical providers.
• Nurture a culture where delivering high quality yields lowest cost and participates in quality assurance activities.
• Drive positive and strategic results related to clinical quality performance measurements and improvement programs.
• Provide critical thinking for analysis, evaluation and modification of data reports (e.g. medical, pharmacy, quality) and assists with the translation of information to knowledge and action to contracted physicians and providers as well as to management and the Board.
• Mentor employees and supports ongoing training and development of clinical staff.
• Support clinical staff to assuring member care achieves the most value for the available benefits.
• Participate in designing and planning for preventive healthcare and chronic disease management.
• Lead the development and implementation of value-based payment models and initiatives including incentivizing provider performance on Medicare Star ratings, risk adjustment, and quality and medical management.
• Oversee the administration of all pre-authorization denials and provides oversight of all cases in which a member appeals a denied authorization of service.
• Prepare for and participates in all cases progressing to an Oregon Health Plan (OHP) hearing due to a services denial.
• Attend monthly meetings of the Oregon Health Plan (OHP) CCO medical directors.
• Maintain contact and collaborates with other OHP CCO medical directors and ATRIO’s medical director.
• Regularly review trends in clinical costs and utilization as well as assist with identifying and managing clinical financial risks.
• Attend and contribute to the Quality Improvement Utilization Review and the Pharmacy and Therapeutics committee meetings.
• Attend organization board meetings and provides input as requested and/or appropriate.
• Contribute to utilization reviews, quality improvement, and risk management activities for ATRIO Health Plans.
• Maintain confidentiality and complies with HIPAA rules and regulations.
• Demonstrate excellent communication skills including presentation, persuasion, and negotiation skills required in working with providers, members and coworkers and including the ability to communicate effectively and remain calm and courteous under pressure.

Selection Criteria

• Ability to perform essential job duties with or without reasonable accommodation and without posing a direct threat to safety or health of employee or others. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Doctoral degree (MD or DO) from an accredited medical school; and five to seven years related experience and/or training.
• Completion of an accredited residency with board certification and an unrestricted active Oregon medical license. MBA or MPH is preferred.