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The Health Plan Chief Medical Officer provides leadership in the development and execution of the Plan's disease management, case management, utilization management, and care management programs.
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You will attend corporate, group, division, and national meetings sponsored by HCA corporate to train and support quality improvement, risk management, patient safety, case management, medical staff affairs, and physician relations activities.
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Solid understanding of the inner workings of medical management activities, including case management, utilization management, quality management, and prior authorization.
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The Chief Medical Officer oversees all clinical management and services of the organization, which includes ensuring regulatory compliance, managing health services team, and being the medical expert for making strategic decisions for the organization.
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Direct reports to the ACNO include, nursing services across inpatient, emergency medicine, ambulatory care, and perioperative & procedural services platforms, as well as therapy services (PT, RT, OT), and social services and case management, Nursing Practice Leaders and House Operations Managers.
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Offers clinical support for appeals and denials process, discharge planning, case management, and utilization review/management. You will lead educational sessions and provides ongoing in-service programs to facility medical staff regarding clinical resource management, appropriate documents standards, utilization and quality issues, and quality improvement activities, in collaboration with the Chief of Staff or other clinical leadership in the facility.
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Oversees and directs the rendering of medical management decisions at all levels of the health plan that maximize benefits for our members while pursuing and supporting corporate objectives.
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Previous discharge planning, care coordination, or case-management experience. Physician leader who is responsible for the overall direction and coordination of all clinical affairs including overseeing Medical Management, Pharmacy Services, Behavioral Health, Health Equity, Employee Assistance Program, and Wellness programs.
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Provides leadership, direction and oversight functions to the health plan's medical management staff designed to achieve best in class performance as defined by identified metrics. Offers a positive leadership role in key health plan medical management initiatives aimed at optimizing utilization of medical resources.
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Enabling services are available to help patients with benefits enrollment, case management, transportation, translation, and patient education. for a community health center, also called a federally qualified health center, in Des Moines, Iowa. Position Details:As the Chief Medical Officer, you will be responsible for:Overseeing and leading the clinical operations of the outpatient health centers.
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As the Chief Medical Officer, you will be responsible for overseeing and leading the clinical operations of our health centers, as well as providing direct care to our patients. Join our team as a Chief Medical Officer and play a critical role in advancing the health and well-being of our community.
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You will serve as a clinical resource and consultant to hospital case managers and hospital staff in the reduction of payer denials and in the denial and appeals process, as requested by the Case Management Department and Patient Accounting Services.
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He/she meets with case management and health care team members to discuss selected cases and make recommendations for care and interacts with medical staff members and medical directors of third party payers to discuss the needs of patients and alternative levels of care.
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You will provide clinical support and consultation regarding cost-effective clinical resource management in the facilities by sharing reports and recommendations regarding how to reduce the variable cost per case while maintaining and enhancing clinical effectiveness.
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The CMO provides senior-level leadership to the infection control, risk management, safety, and medical staff credentialing functions, ensuring the collaboration and coordination of all stakeholders in these processes.
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case management jobs Title: chief medical officer
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