Chief Medical Officer - Health Plan
MD or DO required; MBA or MHA preferred. Licensed (or eligible for licensure) in SD, NE, ND. Board Certification in relevant specialty required.
Minimum 3 years clinical experience that is relevant to the Long Term Care population. This will have included:
- Performing appropriate screening procedures.
- Interpreting laboratory data, identifying appropriate follow-up, reconciling medications.
- Managing both medical and behavioral chronic and acute conditions.
- Performing comprehensive assessments.
Minimum 2 years leadership experience that is relevant to Long Term Care or health plan management.
The Chief Medical Officer - Health Plan will provide leadership of the Institutional Special Needs Plan (I-SNP or “health plan”), providing strategic direction and oversight of the delivery of coordinated clinical services, including plan design/recommended revisions, nurse practitioner model oversight, primary care physician support, case management oversight, risk adjustment of enrollees, and credentialing. This position will be responsible for policy creation that aligns with the priorities of the National Quality Strategy, in collaboration with the Chief Medical and Quality Officer, allowing successful delivery of outstanding clinical outcomes, in a way that improves the resident experience and financial outcomes.
The Chief Medical Officer ensures that the GSS health plan meets the following goals:
- Ensures Members received the highest quality of care and services.
- Ensuring Members have full access to care and availability of primary care physicians and specialists.
- Supervises nurse practitioners to ensure coordination/continuity of care to ensure access to essential services across all healthcare settings, providers and health services.
- Ensures improved communication, member outcomes, access to preventive health services, medication compliance and regimens, safe and appropriate transitions in care, including preventing avoidable emergency room and inpatient admissions.
- Avoiding service duplication.
- Preventing fraud and abuse within the system.
Oversight of nurse practitioner model will include:
- Assures that GSS health plan clinical pathways are in place in all centers, in cooperation with the Clinical leadership of participating nursing facilities, provides education and support as indicated to ensure compliance.
- Coordinates, with the support of recruiting department, the recruiting and selection of health plan nurse practitioners, assures an adequate pipeline for growth and expansion of the health plan.
- Oversees health plan coordination and execution of the Nurse Practitioner orientation, including education and support to understand health plan clinical services platform.
- Implements professional development programs and clinical education for nurse practitioners.
- Ensures that Nurse Practitioners, through use of the Model of Care, are meeting goals and health outcomes of Healthcare Effectiveness Data & Information Set (HEDIS).
Advocacy for the Model of Care will require:
- Collaboration with physicians, case managers, social workers, family members, key care givers and any appropriate ancillary medical personnel as appropriate.
- Regular and effective communication with internal and external parties, including physicians, members, key decision-makers, nursing facilities, health plan employees, and other provider groups.
- Creating Interdisciplinary Care Teams that are individualized according to meet the beneficiary’s clinical and psychosocial needs, as identified by the Health Risk Assessment.
- Ensure that individual plan of care is developed with specific interventions designed to meet the needs identified in the Health Risk Assessment.
- A mechanism to establish and document visit schedule according the Health Risk Assessment stratification (low, moderate, high).
- A process to ensure all Members have an Individualized Care Plan developed within 48 hours of HRAT.
- Actively promote the health plan programs in community (Skilled nursing facility, Assisted living facility, community) by partnering with key stakeholders (i.e.: internal sales function, provider relations, facility leader) to maintain and develop membership caseload.
Advocacy for Quality will require:
- Serves as a champion of Quality Assurance and Performance Improvement Committee.
- Participation in health plan quality initiatives.
- Serves as a member of the Compliance Committee.
- Serve as a member of the Credentialing Committee.
- Makes reports to health plan Board of Directors as requested.
Applicants must apply on our website: www.good-sam.com/careers https://appvault.com/jobs/4979/good-samrms/sioux-falls/general-positions/chief-medical-officer-health-plan/