Chief Medical Officer
The Chief Medical Officer (CMO) based in Wheeling, WV is responsible for leadership of strategic medical management activities and processes which contribute to the performance of the markets and promotes quality of care for our members.
The CMO is responsible for all clinical activities including proper provision of covered services to members, development of clinical practice standards and clinical policies and procedures, and leadership of all medical management activities.
- Leads, develops, directs and implements clinical and non-clinical activities that impact health care quality, cost and outcomes.
- Direct the utilization review process and oversee the quality of utilization determinations.
- Insure compliance with clinical goals through monitoring care management performance.
- Responsible for overall medical policies of the unit to ensure the appropriate and most cost effective medical care is received and for the day-to-day management of medical management staff.
- Develops, implements, and interprets medical policy including medical necessity criteria, clinical practice guidelines, and new technology assessments.
- Provides guidance to clinical staff in the coordination of quality care.
- Provides clinical expertise and business direction in support of medical management programs through participation in clinical team activities.
- Acts as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams.
- Acts as a champion supporting continuous quality improvement efforts to improve the care and services delivered to all members.
- M.D. or D.O. Board Certification in a recognized specialty including post-graduate direct patient care experience.
- Active and current WV State medical license without encumbrances or ability to obtain medical license in WV is a job requirement for this position.
- Previous managed care experience.
- Strong leadership experience, strategic vision and a proven ability to execute on clinical initiatives.
- Excellent communication skills.
- Willing to travel.
- Three (3) to five plus (5+) years of experience in the health care delivery system, clinical and health care industry required with three to five years of additional leadership and management experience managed care.