Landmark Health

Senior Medical Officer

Job Locations US-NC-Durham
Posted Date 5 days ago(7/29/2020 10:37 AM)
Category
Medical Management
Type
Regular Full-Time
Job ID
2020-3991

Overview

Senior Medical Officer will serve as a key member of the management team and report directly to the Chief Clinical Officer and the Market Vice President/General manager. He/she 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.  

Responsibilities

  • Leads 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
  • Collaborates with the Regional Medical Director, VP of Clinical Operations, and Chief Operating Officer to set utilization goals, operational and quality metrics, and oversees all metrics
  • Participates in the development of budgets, staffing plans, medical loss ratio projections, and assuring the adequate allocation of resources to medical management functions
  • In partnership with the Market VP, assists in developing clinical programs, oversee medical management, and drive quality improvement efforts
  • Provides 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.
  • Leads in areas of utilization management, clinical quality improvement, case management, provider relations, concurrent review, and disease management
  • Manages NCQA, URAC, and AHCA qualification activities. Prepares for site visits and responds to accrediting and regulatory agency feedback
  • Oversees 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.
  • Implements and monitors structures and processes which are measurable and flex/change those processes as needed to meet financial, operational, and quality goals
  • Participates actively in provider recruitment and oversees in-service staff training and education for professional staff
  • Maintains up-to-date knowledge of new information and technologies in medicine and their application to the patient population

Qualifications

Qualifications and Experience:

  • 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
  • Must 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 license to practice medicine
  • 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.

 

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