Job Abstract

Valley Health Plan (VHP) is seeking a Chief Medical Officer (CMO) who will support VHP's mission to address the holistic needs of the members served and will be actively involved in the shift toward a value-based, integrated delivery system in collaboration with strategic partners to ensure the delivery of the highest value medical, pharmaceutical, behavioral and social services and supports. VHP's CMO has overall accountability and oversight of all clinical functions and medical cost trends consistent with the vision and strategy set forth by VHP's senior executive leadership team.

• Stays abreast of emerging models of value-based healthcare delivery;
• Identifies and defines new and innovative clinical strategies to support VHP's goals and objectives;
• Develops programs that drive clinical integration, quality and fiscal and service performance;
• Provides medical expertise to all of VHP's operating units, including Provider Contracts Administration, Credentialing, Concurrent In-patient Admission Review, Prior-authorizations, Claims, Marketing and Sales, etc.;
• Ensures the integrity of VHP's clinical processes and provides leadership to the quality management and improvement program;
• Participates in the design and implementation of value-based delivery models and ensure that the technology and analytic infrastructure is implemented to demonstrate achievement of expected performance outcomes;
• Establishes and implements practice guidelines, policies, and protocols compliant with regulatory and accreditation requirements;
• Designs and implements the clinical oversight program;
• Participates or chairs clinical committees as designated;
• Leads the design and implementation of programs and practices to identify opportunities for improvement of quality outcomes and medical cost improvement initiatives.

A board-certified MD or DO with an active, unrestricted California Medical License, five years of clinical practice, and five years of experience in an executive role in a health plan. A MBA, MPH, or MHA and experience in a Knox-Keene licensed health plan is preferred, although not required.

Knowledge of:

• Clinical operations;
• Utilization management;
• Care management;
• Population health;
• Clinical quality management;
• Pharmacy benefit management;
• Population health;
• Performance improvement;
• Value-based reimbursement models;
• Industry-standard clinical guidelines and protocols;
• Process mapping;
• Project management.

• Provide leadership and oversight of managed care principles across the continuum of care, ensuring the provision of care and allocation of resources designed to achieve cost and quality objectives, regulatory compliance, and the improvement of the patient experience;
• Oversee the selection and implementation of technology solutions to support performance and improvement;
• Proficiently work in a managed care environment with a philosophy of collaboration and teamwork;
• Develop programs that drive clinical integration;
• Communicate effectively with a culturally and socially diverse patient population, physicians, and the public;
• Provide direction and leadership to implement changes that will result in revenue and market share enhancement;
• Lead the evaluation of VHP's clinical performance and recommend changes;
• Serve as VHP's clinical expert to the external community relative to VHP's clinical strategy, policies, programs, and delivery model;
• Guide and direct the medical leadership team, including recruiting, coaching, and the development of team members;
• Develop a leadership and management succession plan;
• Actively lead and support a positive proactive, results-orientated culture that demonstrates VHP's mission, vision, and values;
• Communicate effectively, both verbally and in writing, and build consensus.