Job Description

Job Description

eternalHealth – The Next Generation of Medicare Advantage

Healthcare is confusing, but it doesn’t need to be. eternalHealth is a consumer-centric Medicare Advantage Health Plan based in Boston, MA. We are committed to creating long-lasting partnerships with our members, our providers, and you!

About the role: As a Chief Medical Officer with eternalHealth you will work closely with the executive team to provide clinical leadership for the health plan and contracted network, ensuring that our medical practices and care model reflect a commitment to high quality patient care, efficient medical management, and sustainable relationships.

This role also includes standardization and integration of common approach to analytics and performance management, care model evolution, medical management, and clinical quality care across all markets, guided by a system-level set of standards (principles/philosophy consistent with the eternal Health mission and values) and approach, with clear roles and accountability for management value-based lives and performance under a range of risk-arrangements with contracted providers. In coordination with eternalHealth leadership, the CMO is responsible for guiding the design of our model of care, member and provider engagement strategies.

We provide a unique opportunity to be a part of a health plan in its beginning stages, and you will have insight into all the operations and expertise that is required to run a successful and sustainable plan as well as build the foundation for the sustainable growth that will be crucial to eternalHealth’s success. Our team members are flexible and able to play different roles, while staying committed to teamwork and collaboration, and passionate about sustainable change.

Responsibilities:

Clinical Coordination and Integration across eternalHealth – The CMO is accountable for the effective and efficient delivery of all aspects of clinical services to the patients who receive care. This new executive will provide the necessary medical leadership that ensures all medical practices reflect eternalHealth’s commitment to high quality patient care, improved outcomes, efficient medical management, innovative care delivery and sustainable relationships with our patients and providers.

The CMO will collaborate with other clinical leaders within the organization, serving as a resource for the creation and enhancing of policies, procedures, guidelines, and other principles supporting the efficient utilization of resources, the enhancement of service delivery, and the improvement of patient access, satisfaction, and quality. This role will provide leadership in program development, utilization management, process improvement, implementation, and measurement.

Strategic Planning – The CMO will partner with the Chief Executive Officer and other members of eternalHealth’s leadership team in strategic planning and will work collaboratively with key stakeholders toward identification of opportunities for improvement, trend analysis, education and development of appropriate action plans.

Care Model – The CMO will oversee and monitor comprehensive health care initiatives, including oversight of practice transformation & performance management. In addition, the CMO will be the lead clinical strategist for new population health programs and services. They will oversee key clinical programs, population health management initiatives and will provide clinical leadership focused on the continual improvements to the patient experience through use of our combined analytics solutions.

Value-based and Risk-based Management – Across our risk-based and value-based entities and provider networks and lead the implementation and management of a common approach to population health management.

Integration of analytics within medical management – Data and analytics will be crucial for eternalHealth to provide the cutting-edge care and cost savings that will make an impact for both patients and providers. The CMO, in collaboration with the Data & Analytics team and key stakeholders, is responsible for the adoption and integration of a common approach to utilizing our analytics and reporting platforms. The CMO will directly engage in the design and refinement of tools, reports, and workflows to optimize use of data in clinical decision-making, evaluating population- health focused programs and ongoing medical management.

Medical Management – The CMO serves as the key executive overseeing on-going medical management activities including referral management, utilization management, utilization review, and pharmacy management. This new leader is responsible for establishing medical policies and standards of care and developing medical management programs.

Clinical Quality Management – The CMO ensures that the highest appropriate level of medical care is provided to eternalHealth members by overseeing all Quality Improvement and Utilization Review efforts for eternalHealth. They will serve as driver of quality, safety, and cost reduction initiatives.

The CMO will define quality standards to be achieved by all providers and/or responsible for other patients under population health management arrangements, including physicians, facility partners, and ancillary. They will serve as a clinical expert and liaison in value-based activities and maintain a positive and supportive relationship between the inpatient facilities, health plans and physicians.

Requirements:

• Medical Degree with active license
• Minimum 15 years of a combination of clinical practice and medical leadership experience required
• Deep experience with government sponsored payors, Medicaid (Medi-Cal) and Medicare, is essential to this role
• Deep experience in performing and managing under value-based arrangements, specifically including global risk, institutional and professional risk models
• Experience in a senior, P&L accountable leadership role of a risk-bearing entity, preferably in both the provider and payor space, with a significant volume of Medicaid and Medicare membership
• Experience designing and managing offerings to self-insured employers is preferred
• At least 7-10 years of experience in a similar role is highly preferred
• Experience in implementing progressive forms of provider compensation models for both employed and contracted providers preferred
• Prior experience in medical administration settings, with line management responsibility
• Experience working with physicians to strategize and develop measurable improvements which include the quality of clinical care and patient satisfaction
• Knowledge of the HMO industry, managed health care systems, clinical quality assurance, quality improvement and risk management
• Deep knowledge of NCQA, HEDIS, value-based payment models, Accountable Care Organization, Risk Management and evidence-based guidelines
• Experience with peer review process, credentialing process, medical policy and procedure development, and principles of provider contracting
• Demonstrated understanding and experience of working with financial statements and taking on profit and loss (P&L) responsibility
• Experience with creating and implementing clinical redesign and cost savings initiatives based on data-driven information
• Effective coaching and mentoring of staff
• Can coordinate multiple players around specific initiatives, encouraging teamwork
• Creative, strategic, and continuously striving for improvement.
• Flexible and able to ramp-up quickly on different projects in order to support the team as needed in a fast-paced start-up environment.
• Ability to think outside the box and offer creative and compliant solutions to existing and new problems.

Education:

• M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience.

Working with eternalHealth: eternalHealth is an Equal Opportunity Employer which means that we are committed to upholding discrimination-free hiring practices. As a woman-led company, and one committed to diversity at all levels we strive for an organization of inclusion and acceptance. We are changing healthcare for the better, starting with our own diverse and passionate teams. As an eternalHealth employee you will be empowered to contribute to our teams and strategy, regardless of previous healthcare experience. Our valued team members are encouraged and expected to offer new solutions and creative input, all while keeping in line with eternalHealth’s mission, values, and compliance standards.

Accommodations: Any eternalHealth applicant will be considered based entirely on their individual qualifications. Should you require reasonable accommodations during the application process, please contact us separately, email (hr@eternalhealth.com) with the email subject “Reasonable Accommodations – Applicant Name Here”.

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