The National Chief Medical Officer provides leadership, direction, and planning for a wide variety of medical and related activities for Prospect Medical Systems (PMS). This executive serves as the lead clinician for PMS and is the liaison and resource on matters pertaining to clinical activities and directly oversees the CA CMO and the CMO or lead Medical Director of newly acquired entities until they are assigned elsewhere. The NCMO is committed to the mission of quality, safety, service, and improvement of patient clinical outcomes and cost effectiveness. Additionally, he or she is the leader in promoting physician engagement and performance in these areas. The NCO will work closely with the leadership of PMS, CRC and PMH to grow the enterprise.
The National Chief Medical Officer will report to the Chief Executive Officer of Prospect Medical System.
- Directly and thru delegation, develops, reviews, updates, seeks consultation, and implements medical policies and processes that promote and ensure delivery of appropriate clinical care.
- Ensures effective and aggressive utilization management and case management.
- Directly and thru delegation, leads the clinical and operations staff to provide oversight of the care provided to patients. Directly supervise medical directors and others as appropriate.
- Directly and thru delegation, intervenes with individual physicians or clinical staff when there are performance or behavioral issues.
- Directly and thru delegation, partner with the organization-based quality and case managers and other clinical staff to respond to and investigate adverse events; then develop and implement appropriate action plans.
- Partners with the CEO to address physician concerns and develop key physician contracts in collaboration with the CEO, finance, and contracting department.
- Collaborates with leadership to standardize programs and clinical care where appropriate across the enterprise.
- Participates in strategic planning for the network and identify appropriate system level goals and targets.
- Develop state of the art cost containment systems and processes to promote the efficient use of clinical resources.
- Develops and maintains relationships with key healthcare stakeholders including APG, health plan executives, government agencies and competing organizations
- Additional responsibilities may be assigned by the CEO based on needs of the organization. This may include serving as an executive sponsor and mentor for a service line, leading a quality initiative, participating in specialty task forces and other duties as assigned. Special projects or unique local responsibilities may also be added at the discretion of Prospect Medical’s President and CEO based on local needs.
- Strong managed care background. California experience required.
- Knowledge of federal, state, and private health care policies and regulations.
- Experience with incentive or claim based programs to drive utilization management and quality of care.
- MD or DO licensed in the state of California.
- Minimum of five years’ medical director, or equivalent executive/administrative experience within a health plan, IPA, or medical group environment.
- Minimum of three years of direct clinical or acute care experience.
- Demonstrated leadership capabilities.
- Board certified physician.
- Experience working with operational areas within a health plan or IPA.
- Certification or advanced training in operations improvement preferred.
- Leadership experience in a Medical Group or IPA environment strongly preferred.