Vice President Medical Affairs, Government Services - Optima

Location
Norfolk, VA
Salary
Competitive
Posted
Aug 31, 2020
Closes
Dec 10, 2020
Ref
138356BR
Function
Other
Industry
Healthcare
Hours
Full Time
Reporting to the Health Plan Chief Medical Officer and as a member of the division leadership team, the Vice President Medical Affairs (VPMA) Government Business is accountable and serves as the primary clinical interface for internal and external resources on matters relating to the Optima Medicaid plan. The VP and CMO is responsible for driving superior results for quality, population health, growth and external relationship initiatives. Additionally, he/she will implement policies on patient care facilitation, serve as medical liaison with contracted physicians, and communicate plan policy to contracting physicians effectively. The VP and CMO will ensure the organizational objective to have qualified clinicians accountable to the organization for decisions affecting consumers and will actively pursue the development and maintenance of quality of care standards. He/she will serve as a key business partner in network development, product design, strategic planning, regulatory compliance, and community outreach. The VP and CMO will provide leadership and medical insight to the Optima Medicaid line of business and will be responsible for ensuring the delivery of high quality, cost effective medical services to members.

Qualifications

Education Level
Doctor of Medicine OR
Doctor of Medicine - DOCTOR OF OSTEOPATHIC MEDICINE

Experience
Required: Clinical Practice - 10 years, Managed Care Management - 10 years, Management - 10 years, Medicaid Managed Care - 10 years

Preferred: None, unless noted in the "Other" section below

License
Required: Doctor of Osteopathy, Medical Doctor

Preferred: None, unless noted in the "Other" section below

Skills
Required:

Preferred: None, unless noted in the "Other" section below

Other
Board certification in specialty required at time of hire, preferred ongoing recertification. 5 years of clinical practice experience required. 5 years of leadership experience preferred. Knowledgeable of contemporary practice issues within medicine, and outcomes measurement of clinical quality and utilization. Must be familiar with all aspects of health plan operations, especially as related to various state and federal governmental programs. Proven Leadership in areas of Case Management, Disease Management, Utilization Management, Total Cost of Care Management, Population Health Management, Clinical Quality Improvement, Accreditation/Regulatory Standards, Clinical Informatics & Analytics, Human Relations, Risk Management, Patient Experience, Physician contracts & alternative payment models. Understanding of role as executive sponsor for projects and project leadership for health plan responsibilities. Involved with marketing, population health strategies, participates in key strategy discussions. Understands laws and other regulatory bodies impacting health plan operations such as HIPAA, HEDIS, NCQA, STARS, Bureau of Insurance rules & regulations, The Affordable Care Act, etc.

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