Chief Medical Officer, Health Plans

Overview

The University of Utah Health Plan Chief Medical Officer (CMO), is a member of the Health Plan's executive leadership team and provides clinical and business leadership to ensure high quality, coordinated and efficient care for members.

The CMO will work with University Health and community providers and facilities to reduce healthcare costs and improve outcomes.

As part of the integrated delivery system, the CMO will represent the Plan in collaboration with University Health System leaders to develop and implement innovative care delivery and value-based population health programs.

Corporate Overview: University of Utah Health Hospitals and Clinics is an integrated academic healthcare system with five hospitals including a level 1 trauma center, eleven community health centers, over 1,600 providers, and a health plan serving over 200,000 members.

University of Utah Health Hospitals and Clinics is nationally ranked and recognized for our academic research, quality standards and overall patient experience.

In addition to our clinical delivery system, we have a School of Medicine, School of Dentistry, College of Nursing, College of Pharmacy, and College of Health providing education and training for over 1,250 providers annually. We have over 2 million patient visits annually and research grants exceeding $350 million.

Qualified Candidates must have:

• Current licensure to practice medicine in the State of Utah. (M.D. or D.O.).

• Board Certification in their field of specialty.

• Five years of full-time clinical practice experience.

• Experience with population health, case management, or managed care.

• Experience with payment methodologies including value-based care arrangements, risk based arrangements and other managed care models.

Additional preferred qualifications:

• Two or more years as a health plan Chief Medical Officer with preference for direct experience working in a health plan associated with an integrated delivery system.

• Experience in developing and managing Population Health programs.

• Experience working in an integrated delivery system.

As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, diversity, integrity, quality and trust that are integral to our mission. EO/AA

Responsibilities

Job Specific Responsibilities and Accountabilities

• Provide strategic oversight for development and management of policies, procedures, and clinical programs to improve clinical and service quality, reduce healthcare costs and meet other desired business outcomes.

• Combine clinical expertise and financial stewardship to support and optimize health plans programs and support growth.

• Serve as subject matter expert representing health plans in enterprise Population Health and other relevant UofU and strategic and operational committees.

• Engage with community providers and other relevant stakeholders to build and maintain collaborative relationships.

• Collaborate with business owners to support and expand Plan's lines of business including but not limited to commercial (employer group), Medicaid, etc. Ensure services are built and maintained to meet regulatory standards as well as expectations of clients and members.

• Provide direct or matrix management to assigned departments and/or programs.

• As needed, perform reviews on utilization review, appeals and grievance cases.

• Support Sales and Marketing departments in the sales process and interface with clients (employer groups, Governmental entities, etc.) to provide updates on trends, risks, opportunities, and challenges related to healthcare services.

• Stay current with industry clinical trends and administrative trends. Identify opportunities for improvement in medical management, value based arrangements and other areas to enhance programs and achieve outcomes.

• Serve as subject matter expert to lead and support required for NCQA accreditation activities.

• Collaborate with the provider community to establish quality metrics, develop strategies to meet these metrics and maintain processes to necessary to support desired outcomes.

Talent Management

• Hiring, training, developing, and communicating with staff.

Financial Management

• Assist in developing, monitoring, and achieving budget goals for all lines of business.

• Manage labor and non-labor expenses to budget or flex budget.

• Engage with University Health provider leaders to determine efficiencies and quality metrics.

EPE/Service

• Responsible for member satisfaction scores within assigned area(s).

• Responsible for upholding PROMISE standards of direct reports and team members.

Quality

• Responsible to achieve quality goals for assigned area(s).

• Manages and promotes continuous process improvements in assigned area(s).

Performance Management

• Responsible to provide staff feedback on performance, including on-time appraisals and coaching.

• Responsible to deal with conflicts in a proactive manner and to reach resolution in a timely manner.

Building Relationships

• Forms positive relationships with staff, peers, and senior leadership to support the mission, vision, values, and performance standards of the organization.

• Actively engages staff with updates and news as well as involving staff in decisions and work teams. Provides feedback and recognition when appropriate.

Knowledge / Skills / Abilities

• Demonstrated accomplishments and commitment to Quintuple aim to improve quality, reduce costs and improve outcomes.

• Deep knowledge of health plan clinical operations including but not limited to population health, value -based care, risk-based contracts/products and health plan clinical operations.

• Demonstrated in depth knowledge of the health insurance industry including accreditation and regulatory requirements.

• Ability to form positive relationships with staff, peers, and senior leadership to support the mission, vision, values, and performance standards of the organization.

• Ability to perform the KPIs of the position, as outlined above.

• Demonstrated verbal and written communication skills that builds morale and works well with other systems' provider leaders.

• Ability to communicate and collaborate with internal leaders and staff, as well as external stakeholders (delivery system and contracted providers) to achieve goals.

• Knowledge of regulatory and standards of care related to health plans.

• Demonstrated appreciation of cultural diversity and sensitivity towards target population.

• Demonstrated understanding of managed health care systems, operations and accreditation requirements.

• Demonstrated ability to deal with conflicts in a proactive manner and to reach resolution in a timely manner.

Qualifications

Qualifications

Required

• Current licensure to practice medicine in the State of Utah. (M.D. or D.O.).

• Board Certification in their field of specialty.

• Five years of full-time clinical practice experience.

• Experience with population health, case management, or managed care.

• Experience with payment methodologies including value-based care arrangements, risk based arrangements and other managed care models.

Qualifications (Preferred)

Preferred

• Two or more years as a health plan Chief Medical Officer with preference for direct experience working in a health plan associated with an integrated delivery system.

• Experience in developing and managing Population Health programs.

• Experience working in an integrated delivery system.

Working Conditions and Physical Demands

Employee must be able to meet the following requirements with or without an accommodation.

• This is a sedentary position in an office setting that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.

Physical Requirements

Listening, Manual Dexterity, Near Vision, Sitting, Speaking, Standing, Walking