Chief Medical Officer
Richardson, TX

Summary

The Chief Medical Officer (CMO) provides oversight of a comprehensive medical policy implementation and utilization management services. The CMO develops and sustains an interface with member forums and facilitates the delivery of appropriate care. The CMO contributes to the development of the clinical mission of the Service Center, including the development, implementation, and evaluation of clinical/medical programs.

Essential Functions
• Senior Medical Reviewer: Direct the utilization review process and oversee the quality of utilization determinations. Responsible for the quality of the utilization review determinations made in the Service Center. Develop and implement a utilization management program and action plan; ensure compliance with clinical goals through regular   monitoring of the Service Center performance. Evaluate the effectiveness of the clinical program and modify programs as needed to achieve desired results.
• Provide medical leadership, oversight, and consultation for the Service Center Quality Improvement (QI) Program, and Utilization Management (UM) Program including: monitoring effectiveness and compliance with goals, prevention programs, network development and management, quality of care concerns and adverse incidents, medical practice   of network or sub-capitated providers, clinical service delivery system.; coordination with After Hours Team and appeals panel physicians, oversight of clinical appeals. The Medical Director works collaboratively with QI on the development and implementation of QI activities, UM and QI program descriptions, evaluations, and work plans.
• Participate in the development of, implements and interprets medical policy for the Service Center (including Medical Necessity Criteria, Clinical Practice Guidelines and New Technology Assessments).
• Recruit, train, supervise, mentor, oversee, and evaluate the quality of medical staff and physician advisors utilized by the Service Center. Ensure that the Service Center has adequate physician advisor resources. Develop and manage the physician advisor budget.

The CMO shall be involved in:

• Implementation and interpretation of clinical medical policies and procedures;
• Physician recruitment;
• Review of physicians' and prescribers’ network applications and submit recommendations regarding credentialing and reappointment;
• Provider profile design and interpretation;
• Administration of all utilization management and quality management activities;
• Continuous assessment and improvement of the quality of care provided to behavioral health recipients;
• Development and implementation of the QM/UM plan and serve as the chairperson of the QM, UM, and Peer Review Committees with oversight of other medical/clinical committees;
• Provider education, in-service training and orientation;
• Attendance at Monthly ADHS Medical Director meetings; and
• Chairs monthly Pharmacy and Therapeutic (P&T) Committee meetings.

Minimum Requirements

Education
Medical Doctor

Field(s) of Study
Graduate of an American or Canadian medical school accredited by the Accreditation Council for Medical Education (ACME) or equivalent training in a foreign medical school with successful completion of the ECFMG and FLEX examinations. Full training in a residency program in the United States or Canada that is approved by the ACGME.

Experience
5 - 8 years            

Job Specific
Post-residency experience of at least 5 years involving substantial direct patient care during this period at multiple levels of care. Clinical experience pertinent to the patient population(s) being managed.

Other
Familiarity with current research and use of psychopharmacologic and psychotherapeutic modalities of treatment.

Licensure and Certifications
Must have current active license to practice medicine in the U.S.; licensed or licensure eligibility in state of operation; licensure must be complete within the first year of employment; board certification by the American Board of Psychiatry and Neurology.

Preferred Qualifications
Managed care experience preferred, as provider and manager of care. Utilization Review experience preferred. Accreditation experience (NCQA, AAHCC/URAC) preferred.