Job Description
Are you a visionary physician leader passionate about transforming behavioral health? We're seeking a dynamic and experienced Chief Medical Officer to lead our health plan's clinical vision in New Mexico. This is a unique opportunity to shape the future of healthcare delivery and make a lasting impact on the lives of individuals and communities.
About Us:
We're a leading healthcare organization committed to providing high-quality, accessible, and compassionate care. We value innovation, collaboration, and a patient-centered approach. We offer a supportive and challenging environment where you can grow your leadership skills and advance your career.
About the Role:
As the Chief Medical Officer, you will be the clinical leader for our health plan(s) across all lines of business (Medicaid, Medicare, and Commercial). You will be responsible for developing and implementing programs that support our clinical vision, ensuring the delivery of appropriate healthcare through service coordination, utilization management, care/case management, population health/disease management, cost of care initiatives, health promotion, and quality improvement programs. This role requires a leader who can drive parity efforts, collaborate with stakeholders, and analyze data to optimize care delivery.
What You'll Do:
Provide clinical leadership to the interdisciplinary Medical Management team, including oversight, consultation, and training.
Ensure the quality of utilization review determinations, including appeals.
Conduct medical necessity reviews and peer-to-peer reviews.
Oversee case management and disease management programs.
Participate in case rounds and develop case management plans.
Evaluate the effectiveness and cost of clinical programs through data analysis.
Collaborate with external stakeholders, including health plan partners, state agencies, and regulators.
Represent the organization at meetings and deliver presentations.
Lead Quality Improvement (QI) programs, ensuring effectiveness and compliance.
Chair and/or participate in relevant committees.
Recruit, train, supervise, and mentor medical staff and physician advisors.
Develop and manage budgets.
Develop and implement Medical Action Plans to address cost of care.
Implement medical policies and procedures.
Assess technology and clinical standards.
Monitor the quality and quantity of clinical reviews and care plans.
Collaborate with the network management team on integrated clinical-network approaches.
Provide after-hours coverage as required.
Participate in RFP response development.
Maintain licensure requirements.
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 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 CQI processes.
Targeted specialties: Psychiatry, Psychiatric sub-specialty, Primary Care, Geriatrics, Palliative Care, or Physical Medicine.
What We Offer:
Competitive salary range ($222,380 - $422,520).
Comprehensive benefits package including health, life, and voluntary benefits.
Potential for short-term incentives.
A chance to make a significant impact on behavioral health in New Mexico.
Join Our Team:
If you are a driven and experienced physician leader with a passion for behavioral health, we encourage you to apply!
To Apply:
Please submit your resume and cover letter. We are an Equal Opportunity Employer and a Tobacco-free workplace. We value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. 1 Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
1
Employment Type: Full-Time
Salary: $ 222,380.00 Per Year
Job Tags
Full time, Temporary work, Internship, Remote job,