This position is a key member of the executive team, providing expertise in defining the business strategy and direction of the organization, while serving as Magellan?s clinical expert to the external community. This position establishes and leads the overall clinical vision for the organization and continually looks for ways to reinvent how care is delivered in order to support Magellan?s long-term growth strategy. The Chief Medical Officer is accountable for clinical strategy development, product innovation, utilization management and quality improvement programs/policies, and ultimately, the delivery of best possible care and clinical outcomes.
- Stay abreast of emerging models of healthcare delivery and studies on consumer behavior; identify and define new and innovative strategies to achieve business goals and objectives.
- Develop programs that drive clinical integration across business units.
- Provide medical expertise/oversight to all national functional areas including network management, credentialing, claims, marketing and sales, and legal.
- Define how the organization will deliver clinical expertise to consumers in a way that uniquely positions the company in the marketplace, providing an economic advantage and supporting Magellan?s growth strategy.
- Actively engage in business development opportunities including presenting Magellan?s business and clinical capabilities to key customers and prospective customers, including health plans, employers, state and federal regulators, as well as brokers, providers, legislators and analysts.
- Establish Magellan?s clinical leadership by building external relationships and educating key industry thought leaders, participating in industry association leadership and advancing the company?s reputation through industry publications that highlight innovative approaches to care delivery and quality.
- Serve as Magellan?s clinical expert to the external community relative to Magellan?s clinical strategy, policies, programs and delivery model.
- Ensure the integrity of the company?s clinical processes and provide oversight to the national quality improvement program and enterprise quality council.
- Ensure key analytics and development of quality measures are in place for new payment models and products.
- Establish medical policies and guidelines that comply with regulatory and accreditation requirements. Provide interpretation of policy.
- Guide and direct the medical leadership team including recruiting, coaching and development of team members; developing a leadership and management succession plan; actively leading and supporting a positive proactive, results oriented work culture that demonstrates Magellan?s values.
Masters: Business Administration (Required), MD (Required)
License and Certifications - Required
MD - Physician, State Licensure and Board Certified (ABMSor Specialty Board) - Physician
License and Certifications - Preferred
Other Job Requirements
15+ years as a senior leader in managed care, working with primary care and specialty physicians, medical facilities and medical management issues, physicians practicing in groups, government sponsored product lines, media relations and managed care marketplaces., Knowledge and experience implementing successful growth strategies. A passion to serve the "duals" population; understands specialty population risk management, risk stratification and product design. Experience developing innovative product strategies. Strong long-term relationships with key industry customers. Experience developing and directing high-performing teams. Comfort and skill leading in a highly matrixed organization. Demonstrated ability to market appropriate, innovative clinical products that differentiate Magellan Clinical performance and achievement of cost of care goals from competitors. Quality outcomes. Recognized, respected clinical presence in the US healthcare marketplace. Enterprise-wide Leadership: Strong, positive, collaborative relationship with senior leadership team across all of Magellan's product lines, demonstrated leadership team effectiveness, and an engaged/committed workforce