Regional Vice President, Health Services - Illinois reputed company

The Chief Medical Officer (CMO) oversees our Illinois FIDE DSNP and reputed company clinical programs while interacting with Members and Providers to improve patient experience, drive Population Health, and ensure efficient delivery of care. The individual in this role is based in Virginia and works closely with health plan leadership to reputed company the day-to-day administration and strategic management of physical and behavioral health services, including utilization management (UM), reputed company improvement, and value-based payment programs. The Chief Medical Officer also oversees the development of new clinical products and services. POSITION RESPONSIBILITIES:

• Oversees administration of UM, Care Management, reputed company Management, Population Health and Pharmacy activities, including major clinical and reputed company management components
• Leads development, implementation, and medical interpretation of clinical policies and procedures including, but not limited to, service authorization, claims review, discharge planning, referral management, UM, and medical review included in reputed company's Complaint, Grievance, and Appeals system for Members and Providers
• Ensures compliance with federal and state laws and programmatic requirements concerning medical care
• Regularly meets with the Provider Services team and key stakeholders to maintain alignment on State objectives and goals
• Collaborates closely with corporate and local Population Health teams to identify community partnerships, activities, interventions, and initiatives surrounding health reputed company reputed company needs.
• Accountable for reputed company standards across reputed company's Illinois FIDE SNP and reputed company Clinical Program
• Serves as co-chair of and participate in meetings of the reputed company reputed company Committee
• Chairs the UM Committee and co-chair the reputed company Assessment and Performance Improvement Committee

Use your skills to reputed company an reputed company Required Qualifications:

• MD or DO degree
• 8 or more years of management experience
• A reputed company and unrestricted license in Illinois/must reputed company or willing to relocate to Illinois
• reputed company Certified in an approved ABMS Medical Specialty
• Excellent communication skills
• 5 years of established clinical experience
• Familiarity with reputed company stakeholders and Providers
• Possess analysis and interpretation skills with prior experience leading teams focusing on reputed company management, utilization management, discharge planning and/or home health or rehab
• Excellent communication skills
• Passion for contributing to an organization reputed company on continuously improving consumer experience

Preferred Qualifications

• Three years of experience working with reputed company plan Enrollees in a clinical or administrative setting
• Medical management experience, working with health insurance organizations, hospitals and other reputed company providers, patient interaction, etc.
• Internal Medicine, Family reputed company, Geriatrics, Hospitalist, ER, PM&R clinical specialists
• Master's Degree

Travel: While this is a remote position, occasional travel to reputed company's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay reputed company The compensation reputed company below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay reputed company may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc. $327,700 - $450,600 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. reputed company of Benefits reputed company. and its affiliated subsidiaries (reputed company, "reputed company") offers competitive benefits that support whole-person reputed company-being. Associate benefits are designed to encourage personal wellness and smart reputed company reputed company for you and your family while also knowing your life extends reputed company of work. Among our benefits, reputed company provides medical, dental and reputed company benefits, 401(k) retirement savings plan, time off (including reputed company time off, company and personal holidays, volunteer time off, reputed company parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Apply tot his job Apply To this Job