The Chief Medical Officer (CMO) for Catholic Health System Physician Partners (CHSPP) has primary responsibility for clinical oversight and medical management for CHSPP, CHS's Independent Physician Association (IPA) and Medicare Shared Savings Plan Track 1 (MSSP) Accountable Care Organization. The CMO assures that the care delivered by participating physicians and providers meet the standard for quality, timeliness, and appropriateness. He or she works in conjunction with the ACO Physicians, staff of participating hospitals, and senior management to coordinate health services for the IPA and MSSP.
Provides leadership to assure physician engagement in the IPA. Additionally, the Chief Medical Officer assists the IPA's Provider Relations and Performance Improvement Staff with network development, education and performance improvement.
- Provides clinical oversight for all UM/CM/QM activities in the MSSP and IPA
- Collaborates with IPA physician leadership team to set utilization goals that reflect the strategies of the MSSP. This includes the annual development, review and sign off on the MSSP UM goals, UM Plan, and specific MSSP Medical Policies and Procedures.
- Communicates regularly with physician members of the IPA through committee involvement, Board meetings and individual meetings.
- Visits and engages with IPA physicians in their practices and identifies ways that CHSLI can enhance its support and partnership with them.
- Continuously supports the implementation of new and innovative strategies for obtaining desired outcomes and evaluates them for effectiveness.
- Identifies utilization and quality trends and makes recommendations for improvement.
- Provides clinical, coding, and reimbursement expertise as needed.
- Provides clinical expertise and business direction in support of medical care management programs through participation in clinical team activities, policy development and program performance monitoring. Partners with the VP of Operations as dyad partner.
- Provides clinical leadership and overall physician support to all MSSP/IPA physicians.
- Uses evidence based Care Guidelines to drive consistency in MSSP/IPA decision making.
- Works withMSSP/IPA administrators and physician leaders to employ utilization and performance information to identify opportunities to improve care, service, and cost- effectiveness for all providers.
- Active member of the CHS Population Health team.
- Works collaboratively with leaders and colleagues within CHSLI supporting its mission and vision.
- Makes recommendations to the bonus structure to ensure incentives are aligned with the ACO Strategies.
- Participates in provider credentialing activities and business development of provider network for services, sites and service line strategies
- Supports Provider contracting as necessary.
- Leads the Quality, Credentialing and Physician Performance Review Committees of the IPA.
- Active unrestricted MD or DO license in NY is required.
- Active unrestricted Board Certification is required.
- Actively practicing medicine preferred
- 3-5 years of experience in group or IPA/ACO medical management.
- Excellent presentation, written communication skills, and good computer skills
- Strong working knowledge of industry regulations including Medicare, Medicaid and Commercial HMOs and those covering IPAs and related organizations.
- Familiarity with Medical Homes and ACOs.
- Financial and budgeting knowledge and skills
- Experience in team building and development
- Excellent communication skills
- Demonstrated ability to engage physicians and lead change
- Able to provide cooperative leadership and direction to the staff and physician group(s)
- Knowledge of Long Island market is highly preferred
- Prior Managed Care experience is highly preferred
- 3 to 5 + years of experience in the health care delivery system, e.g. clinical and health care industry required, with 3-5 years additional leadership and management experience in the health care industry is a plus.
- Demonstrated ability to make strategic decisions based on a thorough understanding of industry issues, trends and the regulatory landscape.