Location : Hybrid. Most of the positions at YCCO are hybrid, meaning they have the flexibility to work both remotely and in-person at YCCO's office in McMinnville, OR.

Department: Health Services FLSA Status: Exempt

Reports To: Chief Executive Officer (CEO) Physical Strength: Light (L)

Learn more about Yamhill Community Care: click here

Summary

The Chief Medical Officer (CMO) is responsible for leadership of clinically related strategies and operations which contribute to the performance of the organization and promote quality of care for our members by performing the following duties.

Essential Duties

1. Acts as lead clinical and business thought leader to determine clinical strategy, use of healthcare analytics and strategies with delivery system partners to support improved health.
2. Provides strategic and ground level clinical direction in support of Yamhill Community Care (YCCO) transformation and process improvement efforts.
3. Leads internal staff, partnership with external stakeholders and management of delegated relationships.

Job Duties

• Partners with YCCO leadership team to develop, implement, direct, and oversee programs that provide clinical strategy and interventions to YCCO clinical systems.
• Works collaboratively with community stakeholders and providers who interface with medical management including clinical operations, provider contract management, member services and clinically focused vendors.
• Provides the leadership necessary to maintain a motivated, productive, and competent clinical team through open communication and delegation of responsibilities and authority.

Utilization Management

• Ensures stewardship of healthcare resources though utilization management program oversight both internally with staff and with external delegated entities.
• Identifies areas of variation in quality and cost of healthcare services and pharmacy spending.
• Develops solutions leveraging delegated relationships, internal staff development and network contract strategies to address variation.
• Provides clinical oversight and decision-making authority of delegates for benefit determinations and appeals for medical and pharmacy.
• Provides final adjudication for appeals and grievances as needed in partnership with the Quality Assurance team.

Care Management

• Oversees strategic and operational oversight of care management activities, including disease management programs, transitions of care activities, ED utilization control and complex needs case management.
• Provides clinical expertise and business direction in support of care management programs through participation in clinical team activities in the execution of precertification, concurrent review, discharge planning, appeals, case management, disease management and quality management.
• Leads YCCO clinical staff in assuring members' care is coordinated to achieve the most value for the available benefits and that an advocate is available to the member and their caregiver for coordination of benefits.
• Collaborates with provider network medical management leadership to increase effectiveness of medical management programs and to promote the use and integration of other vendor partner medical programs.

Quality Management

• Proactively uses data analysis, predictive modeling, and medical cost forecasting capabilities to identify opportunities for quality improvements and to positively influence the cost-effective delivery of quality care.
• Participates in quality management activities at regional and market levels including those necessary to achieve/maintain YCCO recognition.
• Leads initiatives to improve performance of contracted network on clinical quality metrics to achieve established targets.
• Promotes health equity in organizational programs and initiatives.
• Participates in developing new data informed strategies and the development of effective dashboards to reflect system performance and support aligned efforts.

_Stakeholder & Provider Partnership _

• Represents the health plan in external activities including medical and other professional organizations.
• Participates in activities that enhance YCCO’s image within the community and serves as a representative and medical spokesperson at OHA state meetings, contract negotiations and provider network relations and expansion activities.
• Participates in and/or leads clinically and community focused committees relevant to the Organization including the Clinical Advisory Panel, Community Advisory Council, Medical Necessity Committee, Pharmacy & Therapeutics Committee and Medical Quality & Cost Committees.
• Develops and implements programs for educating participating physicians regarding quality management and utilization management activities.

Value-Based Care

• Partners with contracted providers to address quality and cost opportunities in support of the delivery of sustainable healthcare benefits through value-based care models.
• Works with provider network to implement and support value-based payment models, including the use of shared risk arrangements, quality metrics and data exchange.
• Acts as a liaison between the Organization and state-level entities to help ensure delivery of a value-based care model to meet YCCO contractual requirements.

Clinical Innovation

• Identifies, develops, and implements innovative clinically focused programs to improve access to quality care and manages costs, such as virtual care initiatives.
• Works with community-based organizations to support delivery of comprehensive health solutions addressing the social determinants of health.
• Implements clinical and wellness programs to address the needs of high-risk members.

Management & Leadership

• Trains, supervises, and evaluates performance of assigned staff.
• Ensures program expectations and standards are clearly understood by staff.
• Ensures adherence to department and organizational standards, policies, and procedures.
• Provides staff with the training, tools, and resources necessary to carry out their work.
• Analyzes staffing needs and re-organizes work and assignments as deemed appropriate.
• Supervises assigned staff in a consistent manner.
• Evaluates employees’ performance both informally and formally and takes corrective action to address any areas that need improvement.
• Performs human resource functions in collaboration with Human Resources.

Essential Department & Organizational Functions

• Works to cultivate and develop inclusive and equitable services, and working relationships with diverse groups of employees, community partners, and community members.
• Participates in the preparation and submission of regulatory and contract required deliverables.
• Works closely with other YCCO departments, including Health Plan Operations and Compliance to assist with audits; including the External Quality Review (EQR), as needed.
• Provides coaching and training on specific job responsibilities as assigned.
• Proposes and implements process improvements.
• Meets deadlines for completion of assigned responsibilities and projects.
• Maintains agreed upon work schedule with punctual, regular, and predictable attendance.
• Demonstrates cooperation and teamwork using a professional and respectful demeanor.
• Provides cross-training on specific job responsibilities.
• Meets identified goals that contribute to departmental goals.
• Works collaboratively in a team and matrixed (cross-department) environment with a spirit of cooperation.
• Respectfully takes direction from Supervisor.
• Performs other duties as assigned.

Knowledge, Skills, & Abilities

• Medical policy knowledge and skills as related to quality, case and disease management, credentialing activities and utilization management.
• Clinical knowledge of the management of diverse medical problems.
• Excellent communication and collaboration skills for work with network providers and internal employees.
• Basic knowledge of applicable regulatory and contractual requirements for Medicaid, Medicare, and commercial insurance.
• Ability to implement new and improved approaches to improvement of care and service quality, and to Care Management activities performed by YCCO and/or delegated management service organizations.
• Ability to implement clinical and wellness programs to address the needs of high-risk members.
• Understanding of managed care operations.
• Ability to create excitement and bring individuals and teams together with a common goal and meld into a cohesive unit.
• Ability to work effectively as part of a cross-functional team and foster an environment where change is embraced and supported.
• Ability to deal with issues and problems systemically.
• A track record of successfully managing, developing, and motivating others to meet objectives.
• Proven ability to work as an integral part of a team.
• Ability to plan, set priorities, delegate effectively and utilize time efficiently.
• Experience applying innovative and creative approaches to improve health care delivery.
• Demonstrated use of quality management techniques in a large, organized managed care setting.
• Demonstrated commitment to improving access and quality of care to the underserved and uninsured.
• Appreciation of cultural diversity and the needs of serving a diverse patient population.
• Familiarity with guideline development, outcomes management, population health improvement, disease management and cost effectiveness and cost analysis studies.
• Awareness of physician / provider payment issues, physician practice models and total quality and continuous quality improvement concepts.
• Demonstrated ability to attract, develop and build outstanding, committed and style-diverse clinical teams through collaboration.
• A high degree of diplomacy, credibility, and persuasiveness to consistently cultivate effective working relationships.
• An organized, disciplined, hands-on and process-oriented leader.
• High-energy, persistent, assertive, data driven and focused.
• Excellent organizational skills including ability to handle multiple priorities and demands simultaneously in a dynamic work environment while maintaining high attention to detail and accuracy.
• Ability to work independently, use sound judgment, anticipate next steps and be proactive as part of a diverse team within a Matrix or shared resources across departments work model.
• Excellent computer skills, including Microsoft Windows, Word, Excel, and Outlook.
• Ability to communicate both professionally and effectively in all forms of communication.
• Ability to work in an environment with diverse individuals and groups.
• Ability to remain flexible, positive, and adaptable.
• Ability to work across the YCCO region and to work remotely, as needed.

Supervisory Responsibilities

Directly supervises employees in the Health Services department. Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

Qualifications

Ability to perform essential job duties with or without reasonable accommodation and without posing a direct threat to safety or health of employee or others. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

Education & Experience

Required:

• M.D. or D.O. with
  • Active, Unrestricted Oregon Medical License with
  • Five (5) years’ experience in healthcare delivery system

AND:

• Four (4) years’ leadership and management experience in managed care.

OR:

• Any combination of education and experience that would qualify the candidate for the position.

Preferred:

• Advanced degree in business or public health, preferred.

Certificates, Licenses and/or Registrations

Required:

• Active, Unrestricted Oregon Medical License.
• Current Board Certification in a recognized specialty including post-graduate direct patient care experience.

Physical Demands & Work Environment

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential duties of this position. The work environment characteristics described here are representative of those an employee encounters while performing the essential duties of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit, stand, walk, use hands and fingers, handle or feel, and reach with hands and arms. The employee is occasionally required to climb or balance, stoop, kneel, crouch or crawl. The employee may occasionally need to lift and/or move up to 25 pounds.

This position operates in a professional office environment and requires frequent use of standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. Specific vision abilities required by this job include close vision, color vision, distance vision, depth perception, and ability to adjust focus. The noise level in the work environment is usually moderate.

This position may include occasional required or optional travel outside of the workplace, in which the employee’s personal vehicle, local transit, or other means of transportation may be used.