CMO MBM - Carelon

Description

Location : Within 50 miles of a PulsePoint office. Preferably IL, IN, or TN.

Summary:

A proud member of the Elevance Health family of companies, Carelon Medical Benefits Management, is a benefit-management leader in Illinois. Our platform delivers significant cost-of-care savings across an expanding set of clinical domains, including Radiology, Cardiology, Oncology, HH and DME.

Responsible for serving as the chief medical officer (CMO) for Carelon Medical Benefits Management Specialty Health. The CMO is a member of the Carelon executive team reporting directly to the CEO and is responsible for the overall clinical performance and integrity of all Carelon solutions ensuring that all programs improve the appropriateness of care, patient outcomes and reduce cost. He/she is the lead clinical spokesperson for the company interacting with internal and external clients and stakeholders including national and state professional associations and societies; state and national governmental and regulatory agencies; and accreditation organizations. This individual is expected to develop strong relationships with client CMOs and other executives and be a strong partner to the Solutions, Sales, Client Partnerships and Operations organizations within Carelon.

Team Scope:

The CMO leads a team of 10 Direct reports and about 80+ indirect reports which are domain expert clinicians who are responsible for the clinical development of their respective solutions, including the overall strategic approach, program design, and clinical underpinnings (clinical evidenced based guidelines that are the foundation for the interventions which will be made by Carelon on behalf of its clients.) These clinicians contribute to program innovation and evolution over time to increase efficiency and impact.

The CMO is also responsible for leadership of the Clinical Program and Solution Authoring Organization which performs the evidence discovery and curation, critical components of guideline development and maintenance as well as translation of the guidelines into system useable algorithms that support Carelon's automated, portal based prior authorization capability. In partnership with the Solution Medical Directors, The Solution GMs and Operations the Clinical Programs and Solution Authoring Organization works to continuously improve the performance of Carelon's solutions supporting delivery of higher value from a quality and cost perspective.

Finally, the CMO oversees Carelon's Elevance Health relationship supporting the Elevance Health client management organization, the Elevance Health implementation team as well as overseeing Carelon's Cost of Care (CoC) program which focuses on developing programs and initiatives that will support Elevance Health's annual CoC targets.

Primary duties may include but are not limited to:

• Ensuring the clinical integrity of Carelon's clinical solutions from development through delivery.

• Supporting sales and client management.

• Represent Carelon in partnership with the CEO and SVP of Client Partnerships externally to client executive teams, and national and state-based organizations.

• Lead the relationship with Elevance Health clinical and non-clinical leaders.

• Delivery of Carelon's annual cost of care targets working closely with the Elevance Health CoC team and the teams at AIM responsible for execution and delivery.

• Recruitment, retention, and career development across his/her areas of responsibility.

• Monitor competitors' products, emerging companies, and technologies as sources of ideas for innovation and improvement.

• Collaborate with others to continually drive innovation and improvement that support greater value and ease of implementation and use.

• Identify potential partnership and acquisition opportunities and participate in the evaluation of these opportunities.

• Support clinical collaboration across Carelon to enhance its program and service offerings.

Position Requirements:

• Licensed and Board-Certified Medical Doctor.

• Advanced business training highly desirable (MPH, MBA, or similar).

• A minimum of 5 years of clinical experience. 10 years of progressive health care leadership/management experience across multiple segments of the industry

• Thorough understanding of all aspects of the US health care system including but not limited to health care economics, health care delivery, utilization management, case management, utilization review, health insurance, government programs etc.

• 5-10 years leading physician teams in either payor or managed care organizations.

Preferred Skills, Capabilities and Experiences:

• Experience working with all lines of business (Medicare, Medicaid, and Commercial)

• Demonstrated experience in product development, voice of the customer and consulting.

• Proven ability and experience interfacing with member experience, compliance and claim operations.

• Demonstrated ability to deliver effective presentations to all size groups.

• Demonstrated ability to work collaboratively with other clinicians and non-clinicians.

• Demonstrated experience and effectiveness in motivating and mentoring others who are in a direct reporting relationship.

• Ability to communicate effectively in writing, orally and with others to assimilate, understand and convey information in a manner consistent with job functions. Prepare clear and concise reports, correspondence, thought leadership pieces and other written materials.

• Demonstrated experience working on programs for care, case, and disease management.

• Experience with clinical coding (ICD-10, CPT, etc.), medical informatics, and EMRs.

Corporate Title: Carelon MBM Exec - Medical

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $297,000 to $534,672

Locations: California; Colorado; Hawaii; Nevada; New York; Washington State; Jersey City, NJ

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws .

• The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.comfor assistance.