Job Description

Overview

As the Executive Clinical Leader in the Oregon market, you will focus on delivering best in class clinical leadership and support by partnering with Sales, Network Management and clinical teams to provide clinical leadership within the Oregon market.

Responsibilities & Requirements

Strong clinical consultant capabilities to work with cross functional teams to support the market and customers
+ Detailed understanding of current Care Management programs and ability to work with clinical teams for custom solutions or programs
+ Strong data analytic capabilities to support the identification of cost drivers and solution development based on client needs/conditions
+ Experienced presenter comfortable in customer and prospect settings to represent the full continuum of solutions with ability to speak at level of all stakeholders
+ Detailed understanding of market landscape and continuously seeking knowledge on competitors and third party solutions
+ Strong understanding of network and linkages of clinical programs with value based care to support the development of book of business and customer specific solutions.
In partnership with other physician and clinical leaders, take action to positively impact key clinical performance indicators across the health plan (admits/thousand, readmissions/thousand, ER utilization, cost of care, etc.).
+ Understand and interpret clinical data to provide subject matter expertise and consulting on a variety of medical management and policy issues that arise throughout the year.
+ Lead and/or participate on cross functional task force focused on identification of solutions to impact cost and utilization, quality and/or patient experience.
Identify and implement short and long-range strategies to reduce medical cost trend and achieve medical cost savings targets across the health plan and national account customers.
+ Identify the factors impacting medical cost trend, utilization, quality and develop solutions and interventions.
+ Stay abreast of industry, medical, and technology trends and chair or participate on workgroups related to development of medical policies and/or strategies.
+ Collaborate with others to implement solutions to reduce cost trend or utilization.
Support market-based Provider Network, Contracting and Provider Partnership Innovation.
+ Partner with Provider Partnership Innovation Team to prepare for Joint Operating Committee (JOC) meetings with local providers related to value-based contract arrangements. Analyze data to determine opportunities for improvement and to help achieve success. May present/interpret data to provider during JOC.
+ Lead or support network initiatives as needed in the market to further value based care position in the market.
+ Clinical lead in the market with providers and driving the discussion to support overall quality improvements with providers and market level quality initiatives (e.g., BREE).
+ Provide oversight of clinical aspects for network management team.
+ Build relationships with CMOs and CEOs of Washington delivery systems
Serve on the Executive Leadership Team for the state and provide clinical leadership necessary to promote sales growth and retention.
+ Support Sales and Account Management Teams by partnering on sales strategies, RFP responses, and presentations for new accounts. Provide Utilization Cost Reviews (UCRs) for current accounts.
+ Expand market presence through external speaking arrangements and participation in local community initiatives on cost, quality and patient experience.
+ Monitor and report on cost of care, quality and health outcomes issues within the local market and ensure alignment between state and organizational priorities.
+ Provide external clinical face for Cambia regarding a variety of medical issues e.g. legislative or community affairs activities.
Serve as physician leader for assigned departments, work teams, projects or lines of business
+ Develop and communicate strategies, effectively manage resources or programs, achieve operational goals.
+ May manage staff including hiring, performance management, development and retention and may participate in talent planning discussions within Health Care Services.
Minimum Requirements:

The Executive Medical Director would have a MD or DO degree (also prefer a MBA, MPH, or MHA degree), at least 5 years clinical experience, plus healthcare and/or health plan leadership experience, or equivalent combination of education and experience.

Proven track record of leadership in clinical field with detailed understanding of health plan carrier and delivery systems

Demonstrated competency working with hospitals, provider groups, or integrated delivery systems to reduce healthcare costs and improve outcomes through both understanding detailed utilization and reporting and deve
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