Deputy Chief Medical Officer
Description
PURPOSE OF POSITION
The Deputy Chief Medical Officer is a key member of the senior executive team responsible for ensuring access to high quality healthcare for the members of 1199SEIU workers in New York’s healthcare industry. He/she supports the Chief Medical Officer to address a wide variety of issues related to the benefit plan design and management of the overall business strategy and direction of the Fund. Reporting to the Chief Medical Officer, this position leads the effort to assess, manage and implement programs to improve quality of health care for our members. He/she provides clinical direction to the leadership staff engaged in ensuring access to high quality, cost-effective health benefits for multi-employer benefit plan members, including but not limited to medical, prescription, vision, dental, behavioral health and wellness. Responsibilities also include analysis of complex technical data to assist in recommendation and development of value-based plan design based on proven medical interventions, high value therapies and efficacy.
ESSENTIAL RESPONSIBILITIES
Strategy & Policy:
▪ Participates in policy review, performs analysis and makes recommendations; design and implement action plans to improve plan and network managed care performance.
- ▪ Maintains up-to-date knowledge of new information and technologies in healthcare and their application to the health plan; recommends changes in plan design in concurrence with industry changes.
▪ Identifies opportunities to collaborate and develop clinical integration opportunities with health delivery systems to achieve affordable outcomes.
▪ Participates in senior management strategy development and implementation.
▪ Supports the Chief Medical Officer to develop and implement strategic goals related to the quality improvement, utilization management programs and chronic care management.
▪ Assists in providing strategic direction on benefit plan design for each Fund. Leads and implements the clinical direction for the organization.
Member Education, Engagement & Healthy Living Initiatives:
▪ Provides rigorous, consistent and disciplined oversight and analysis of benefit programs to ensure healthcare services to members are of high quality and cost effective.
▪ Promotes wellness and ensures programs of prevention, education and outreach to members and providers consistent with the Funds mission, vision and values.
▪ Oversees the healthy living initiatives and their programs.
Outcome Measures & Analytics:
- ▪ Creates and maintains programs that incentivize providers to achieve selected utilization/cost and quality outcomes.
- ▪ Achieves and maintains benchmarked utilization and cost management goals and clinical quality improvement objectives.
- ▪ Uses data analysis to identify opportunities for quality improvement and to positively influence benefit plan designs.
- ▪ Assists the contracting process of providers, hospitals, ancillary providers, by evaluating the medical aspects of provider contracts in keeping with Funds’ goals of value based benefit design and contracting initiatives.
Operations:
▪ Plans, organizes, and directs clinical management programs.
▪ Works collaboratively with operations to implement policy decisions.
▪ Provides clinical guidance, support and education to the key clinical staff.
▪ Represents the fund at meetings with key stakeholders i.e. large physician groups, etc.
▪ Responsible for the development of budgets, staffing plans, assuring the adequate allocation of resources.
ADDITIONAL RESPONSIBILITIES
▪ Represents the organization at internal and external functions and meetings
▪ Performs special projects and assignments as directed by the Chief Medical Officer and/or Executive Director
EDUCATION &/or EXPERIENCE REQUIREMENTS
▪ Doctorate Degree in Medicine; advanced degree in business or public health desirable
▪ Board Certified (primary care or internal medicine preferred); active and current state medical license without encumbrances.
▪ 10 years leadership experience in the health care delivery system, e.g. clinical and health care industry required; HMO/Managed Care leadership and management experience
KNOWLEDGE & SKILL REQUIREMENTS
▪ Knowledge of managed healthcare systems, medical quality assurance, quality improvement and risk management.
▪ Experience with economic analysis in the healthcare arena
· Superb analytical skills with ability to analyze health claims data including utilization and costs in a health benefits or health insurance environment and arrive at valid conclusions, recommendations, and plans of action
▪ Strategic and innovative thinker with proven ability to communicate a vision and drive results
▪ Demonstrated management, organizational and interpersonal skills.
▪ Ability to solve problems and execute on initiatives.
▪ Ability to work collaboratively internally and externally.
▪ Self-assured and results oriented.
▪ Experience and demonstrated successful leadership of case management, disease management and/or population health programs.
▪ Demonstrated ability to assess business needs, design and implement programs and evaluate results.
▪ Demonstrated ability to make strategic decisions based on a thorough understanding of plan design, industry issues, trends and the regulatory landscape.
▪ Strong leadership, business, and healthcare industry acumen
▪ Must have the ability to plan, coordinate, and direct the work of subordinate staff engaged in various professional, technical, and clerical functions
· Knowledge of multi-employer plans and benefit programs sponsored and administered by boards of trustees made up of both labor and management a plus.
· Superb analytical skills
We offer extraordinary benefits including outstanding health, dental, pension and family benefits for most positions which are paid entirely by the Funds without co-payments, deductibles, or out-of-pocket expenses for covered services. We also offer tuition reimbursement, generous holiday, vacation, and sick leave, as well as a 401K plan.
