Achieving our ambitious Cause requires exemplary leadership. In addition to the Cambia values listed above, our leaders demonstrate the following leadership attributes: Cambia leaders think big, push boundaries, envision possibilities, inspire and empower others. They build collaborative relationships beyond their functional area and create workplaces which are just and transparent. Our leaders must be lifelong learners, develop others and act as role models for their teams, colleagues, external partners and—most importantly—our current and future members.
Responsibilities & Requirements
- Provides leadership in development and oversight of medical policies, clinical programs and competitive strategies to improve clinical performance and achieve business objectives.
- Identify improvement opportunities and champion and drive change related to clinical outcomes, cost effectiveness and improved member experience.
- Manage assigned departments, programs, line of business or vendor partnership.
- May manage staff including hiring, performance management, development and retention and may participate in talent planning discussions within Health Care Services.
- Provide internal and external executive leadership to promote provider partnership and business growth with key stakeholders and accounts. Communicate in various forums as a medical and health plan subject matter expert.
- May manage VIP cases and higher-level appeals.
- Stays abreast of industry, medical and technology trends. Identifies and communicates new opportunities in utilization management, provider contracting or other areas that would enhance outcomes and the reputation of the organization.
- Executive Medical Director would have a MD or DO degree (also prefer a MBA, MPH, or MHA degree), 5+ years clinical experience, plus 4+ years health plan managed care experience and leadership, sales and/or provider partnership experience, or equivalent combination of education and experience.
- Demonstrated competency working with hospitals, provider groups, or integrated delivery systems to reduce healthcare costs and improve outcomes.
- Excellent communication, influencing, presentation and facilitation skills with all levels of the organization and executive-level external partners, including the ability to creatively resolve complex issues, build consensus among groups of diverse stakeholders.
- Proven ability to develop and maintain positive working relationships with provider, vendor, community and account partners.
- In-depth knowledge of the health insurance industry, state and federal regulations, provider reimbursement methods and evolving accountable care and payment models. Proven capabilities to drive change related to population health and healthcare transformation.
- Strong knowledge of health plan clinical practices, programs and processes. May need to demonstrate subject matter expertise in a particular discipline or line of business (e.g. Behavioral Health, Palliative Care, Medicare)
- General business acumen including understanding of market dynamics, financial/budget management, data analysis and decision making. Expertise in applying data and best practices to manage health and quality outcomes.
- Proven ability to develop creative strategies to accomplish goals and objectives, plan and execute complex projects and programs, and drive results across internal teams and/or external partners.
- Ability to effectively coach and manage others. Experience driving change and managing deliverables.
- Current or previously licensed Physician with an MD or DO degree.
- If doing medical determinations must have an active, unrestricted license to practice medicine in one or more states or territories of the United States. Board Certification is required, in primary care specialties preferred.
- Qualification by training and experience to render clinical opinions about medical conditions, procedures, and treatments under review.