Chief Medical Officer
San Antonio, Texas

JOB DETAILS
Large national Health Plan is seeking a Chief Medical Officer for its statewide Texas network.

DESCRIPTION
The Chief Medical Officer is responsible for managing the total medical costs that are incurred for the Texas plan. This responsibility also specifically includes the review and approval of all Provider, Facility, and other health care-related network and individual contracts. In addition, other duties may be assigned.

Essential Job Functions
The Chief Medical Officer has the responsibility for managing the total medical costs that are incurred by the Texas health plan. The Chief Medical Officer also has the specific responsibility for the review and approval of all Provider, Facility, and other health care-related network and individual contracts. The Chief Medical Officer’s responsibility includes the direct, day-to-day oversight and management of the state health care services departments and associated personnel. These health care services departments include, but may not be limited to Utilization Management, Quality Improvement, Pharmacy Management, Credentialing and Behavioral Health functions. In addition, other duties and responsibilities may be assigned to this position. The Chief Medical Officer provides strategic direction and innovative problem solving capability to the state health care and contracting services and the state Chief Executive Officer, while serving as a member of the state senior executive team.

Qualifications

Education
Board Certification in a specialty recognized by the American Board of Medical Specialties with a preference for primary care (Family Practice, Internal Medicine, or Pediatrics). Post-graduate education in Health Care Administration, Public Health or an M.B.A., or the equivalent experience is desirable.

Experience
Five to ten years experience in general and medical managed care administration, with senior line medical management experience in Utilization Management, Quality Management, Provider and Facility contracting, provider relations, credentialing, NCQA accreditation, HEDIS measures, and Medical Policy development.

Licensure
Valid Texas Medical License without restrictions, free of Medicaid or any other government program sanctions.

Additional Skills and Knowledge
Computer literacy; Excellent verbal and writing skills; Excellent interpersonal communications skills; Proven problem solving and analytical skills; Hands-on experience in Managed Care Provider. Facility and other health care service contracting and contract negotiations; a firm knowledge base in Care Management and Disease State Management paradigms; Experience in developing and utilizing Medical Informatics reporting and Provider Profiling functions.