The Senior Medical Officer will serve as a key member of the management team and report to the Vice President. They will work closely with the Landmark senior executive team, having primary responsibility to provide clinical direction and manage Landmark’s clinical development initiatives in order to further growth, ensure high quality patient care, excellence in client relations and meeting of all financial, operational, and quality metrics.
• Lead as an active and hands-on member of the senior management team to plan and execute adjustments to the clinical delivery model and operations to meet changing needs
• Works with the Regional Medical Director, VP of Clinical Operations, and Chief Operating Officer to set utilization goals, operational and quality metrics, and oversees all of these metrics
• Participate in the development of budgets, staffing plans, medical loss ratio projections, and assuring the adequate allocation of resources to medical management functions
• Develop clinical programs, oversee medical management, and drive quality improvement efforts. Provide leadership, direction, and administration of clinical operations to ensure compliance with Landmark objectives towards the realization of quality, cost-effective health care services
• Builds and maintains positive relationships with health plan business and operational counterparts.
• Assigns Landmark clinical resources to meet stakeholders’ expectations—health plans, members, family members and Landmark colleagues.
• Lead in areas of utilization management, clinical quality improvement, case management, provider relations, concurrent review, and disease management
• Manage NCQA, URAC, and AHCA qualification activities. Prepare for site visits and responds to accrediting and regulatory agency feedback
• Oversee risk management, claim adjudication, pharmacy utilization management, catastrophic case review, outreach programs, HEDIS reporting, site visit review coordination, triage, nutrition service review, provider orientation, credentialing, etc
• Implement and monitor structures and processes which are measurable and flex/change those processes as needed to meet financial, operational, and quality goals
• Participate actively in provider recruitment and oversee in-service staff training and education for professional staff
• Maintain up-to-date knowledge of new information and technologies in medicine and their application to the patient population
• Must possess in depth knowledge and experience working within and/or in partnership with community health plans.
• Strong internal medicine and comfort caring for highly complex patient populations
• Must possess leadership and people management skills and have successfully demonstrated the ability to build and develop a strong medical management team
• Previous leadership experience in either a fully delegated medical model or in a health plan with a complex care delivery model
• Expertise in either delegated risk models or working under cap structures with a strong focus on metrics and quality indicators
• Deep experience in informatics and analytics
• Experience in quality assurance, utilization review, and program development coupled with strong implementation skills
• Degree from an accredited medical school with Board Certification or Board Eligibility, preferably in the clinical specialty of primary care. Unrestricted Physician license to practice medicine in NY.
• Experience developing and managing clinical programs, focused on the chronically ill and managing medical expense
• Ten (10) years of clinical / management experience preferred in health care.
In order to work with potentially vulnerable patient populations and to keep employees healthy while caring for patients, all patient-facing employees of Landmark must provide evidence of the following required immunizations/vaccinations as a condition of employment: TB, MMR, Tdap, and Influenza. Declinations may be accommodated based on your medical history, an allergy or religious beliefs. Please immediately contact HR if you wish to apply for an exemption from our vaccination requirements so that we may determine if you qualify for an accommodation.
Valid through: 6/29/2021