Job Description
Lead the Way in Behavioral Health! Are you a passionate and experienced physician leader with a focus on behavioral health? We're seeking a dynamic Senior Medical Director to serve as our Chief Medical Officer for our health plan in New Mexico. This is a fully remote position, allowing you to work from anywhere in the state. If you're ready to shape the future of healthcare and make a real difference in the lives of our members, we encourage you to apply!
What You'll Do:
Set the Clinical Vision: Provide clinical leadership for all lines of business (Medicaid, Medicare, and Commercial), implementing and managing programs that support our vision for exceptional care.
Oversee Key Programs: Direct service coordination, utilization management, care/case management, population health/disease management, cost of care initiatives, health promotion, and quality improvement programs.
Champion Parity: Lead parity efforts, ensuring compliance and maintaining up-to-date documentation.
Ensure Compliance: Guarantee consistent implementation of medical policies, clinical guidelines, and quality/clinical operations policies, maintaining NCQA and/or URAC compliance.
Analyze Data: Use utilization, quality, and financial data to drive high-quality, cost-effective care delivery.
Mentor and Supervise: Oversee the work of Medical Directors and Physician Advisors, providing guidance and support.
Engage with Stakeholders: Build strong relationships with providers, health plan partners, members, and state agencies, promoting our commitment to clinical excellence.
Drive Quality Improvement: Lead Quality Improvement (QI) programs, monitoring effectiveness, ensuring compliance, and developing NCQA-compliant clinical quality improvement activities.
Manage Resources: Develop and manage medical director, physician advisor, travel, and continuing medical education budgets.
Develop Medical Action Plans: Create and implement Medical Action Plans (MAPs) to address cost of care, including utilization and quality metrics.
Influence Medical Policy: Provide input on medical policy development and participate in relevant committees.
Ensure Quality Reviews: Monitor the quality and quantity of clinical reviews and care plans.
Collaborate with Network Management: Work closely with the network management team on an integrated clinical-network approach, including provider relationships.
Provide After-Hours Coverage: Share in after-hours coverage responsibilities as needed.
Participate in RFP Responses: Contribute to the development and writing of RFP responses.
What You'll Bring:
Targeted specialties: Psychiatry, Psychiatric sub-specialty, Primary Care, Geriatrics, Palliative Care, or Physical Medicine.
MD or DO degree, or MBBS degree with required US training and certifications.
Graduation from an accredited American/Canadian medical school or equivalent foreign medical school training with required US certifications.
Completion of a US or Canadian residency program approved by the ACGME.
At least 7 years of post-residency experience with substantial direct patient care.
Clinical experience relevant to the patient populations being managed.
Unrestricted, current, and valid medical license in a US state or territory.
Strong leadership skills and the ability to drive change.
Experience with cost-benefit analysis, medical decision analysis, credentialing, quality assurance, and continuous quality improvement (CQI) processes.
What We Offer:
Competitive Salary: $222,380 - $422,520 (This range is based on national data and may vary based on location and experience).
Comprehensive Benefits: A wide range of health, life, voluntary, and other benefits and perks to support your physical, mental, emotional, and financial well-being.
Opportunity to Make a Difference: Lead transformative change in behavioral health and improve the lives of our members.
Remote Work: Enjoy the flexibility of working from anywhere in New Mexico.
Employment Type: Full-Time
Salary: $ 222,380.00 Per Year
Job Tags
Full time, Remote work,