Chief Medical Officer (CMO) - Michigan HIDE

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The Regional VP, Health Services relies on medical background to create and oversee clinical strategy for the region. The Regional VP, Health Services requires an in-depth understanding of how organization capabilities interrelate across segments and/or enterprise-wide. The Regional VP, Health Services will provide medical leadership and strategy for the Health Services Operations with fiscal responsibility for trend management.

* Oversee regional utilization management and case management for inpatient cases (acute care hospital, LTAC, Acute rehab, SNF), LTSS services, according to the Humana Medicare Model of Care.

* Participate in Quality Operations including chair Quality Management Committee, complete initial peer review on quality of care complaints, complete peer-to-peer written and verbal communications.

* Oversee administrative budget for regional HSO & Quality Improvement including approve/deny expense reports & requisition requests for department members.

* Oversee Quality Improvement and HEDIS/STARS metrics improvement with PCP offices and IPAs.

* Participate in regional level committees and meetings setting medical necessity strategies.

* Provide oversight and direction for the implementation of regional clinical programs and strategies, as well as, developing and implementing market level strategies.

* Manage internal operational/functional relationships related to profitability.

* Assist with network development and provider contracting with various providers and ancillary providers.

* Serve as clinical liaison with inpatient facilities and joint operating committees to maintain facility relationship and problem solve; especially reviewing contracts as to clinical services.

* Well-versed on financial aspects of various levels of risk bearing contracts and possess the ability to gain traction and adoption of the providers.

* Ability to thrive