Job ID:CA-IH-4166
Job Title:CMO - DO NOT POST
Rate:
Primary Skills:
Description:

Chief Medical Officer – Greater Los Angeles  
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(* Please note this is a general overview of this CMO opportunity and a formal description is under development.).  
Exceptional opportunity to spearhead initiatives in clinical operations, UM, quality, performance improvement for a growing health plan.
Lead clinical teams in achieving improvement in HCAHPS scores and quality metrics .
Serve as a clinical advisor to and educator of medical management staff making sure correct clinical judgment is applied to all medical management determinations.
Oversees internal medical review guidelines to ensure clinical integrity and compliance and acts as a resource for staff members throughout the operation.

Coordinates with other departments, the responses needed to address regulatory accreditation concerns pertaining to medical management issues

 Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services.

Responsible for physician review and oversight of all potential adverse determinations including pre-certifications/prior authorizations, concurrent review and appeals/retrospective review.

 Actively participates in the auditing process of medical management processes and corrective action team projects for medical management

 Achieves utilization, cost management and quality goals.

Qualifications:

- MD or DO
- Board certification in a specialty recognized by the American Board of Medical Specialists.
- Previous experience as Medical Director is required.
-Master’s degree in Business Administration, Public Health, Healthcare Administration or related field preferred.

Current California medical license without restrictions is required.