The Chief Medical Officer (CMO) reports to the CEO and is an integral member of the executive leadership team. The CMO is responsible for building a strong vision, within and between the Concerto team and health plan executives. This position will support policies, goals and objectives established and approved by the CEO and Board of Directors.
This role is responsible for leading Concerto’s medical management activities including utilization management, care management, quality & accreditation, and clinical policy formulation. This role is responsible for ensuring that Concerto patients receive high quality care in the most affordable and appropriate settings. This role will partner with Concerto’s Chief Operating Officer and Chief Clinical Transformation Officer (responsible for field-based direct delivery of care) to optimize the quality, quantity, and cost of healthcare services delivered to Concerto’s patient population. The Chief Medical Officer is responsible for establishing within these departments systems of accountability, optimizing organizational design, monitoring and reporting individual and team performance, and achieving clinical quality and business goals.
The successful candidate will have strong operational skills and a data-driven managerial orientation that will enable them to anticipate operational needs and achieve desired quality and cost outcomes in a rapidly-growing business environment.
Develop and implement a strategic vision and plan to deliver high-quality health care services to culturally diverse membership that traditionally lacks access to comprehensive, high quality medical care.
Define technology and data needs to support clinical programs and quality measurement.
Develop utilization management criteria and clinical protocols, analyze trends, and implement policy, program, and practice changes designed to achieve effective outcomes.
Monitor physician compliance with contractual responsibilities, particularly in the areas of utilization review and quality management.
Develop role-specific productivity standards and maintain systems to monitor individual and departmental performance to ensure compliance with contractual and regulatory performance requirements based on community, state and national practice guidelines.
Perform continuous quality improvement activities to ensure the ongoing quality and efficiency of health care delivery to Concerto patients.
Ensure effective communication and operational integration with Concerto’s field-based direct-delivery capabilities.
Develop and execute a corporate quality strategy regarding national accreditation standards (e.g., NCQA)
Perform other duties and special projects as assigned.
Current Doctor of Medicine or Osteopathy with an active and unrestricted license. Board certification in a relevant specialty.
Five years of experience in a managed care environment, physician group management, or integrated health care system management in value based/risk arrangement strongly preferred.
Operational experience managing utilization management, care management, clinical audit, and related health service operations.
Successful experience managing external customer relationships (e.g., health plans, medical groups, regulators, etc.)
Proven track record with tangible results in clinical quality improvement and cost management.
Ability to integrate clinical and financial data for improved management of clinical programs.
Experience serving culturally diverse populations.
Internal Number: CH-HQ-CMO-2018
ConcertoHealth Inc. is the leading provider of specialized primary care and supporting clinical services for complex, frail, elderly, and dual-eligible patients. Operating exclusively as a delegated provider organization under value-based contractual arrangements, ConcertoHealth provides high-touch, individualized care for patients, and deploys wraparound clinical resources that extend the reach of health plans’ primary care networks. This comprehensive medical management solution, elevated by Concerto’s proprietary population health technology, improves overall healthcare quality and access, patient outcomes, the provider experience, and total cost of care - all of which benefit Concerto’s payer partners and their provider networks. The Concerto name reflects our unique approach to healthcare; it’s about how we work in concert with patients and their families, providers, and health plans. Our approach focuses on bringing harmony across the spectrum of a patient’s care, health, and dignity.
The company is headquartered in Aliso Viejo, CA. For more information, please visit: www.concertohealth.com