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Associate Chief Medical Officer – VP, Population H

AvMed, Inc.
Position Description
Associate Chief Medical Officer – VP, Population Health
July 2018

AvMed is a Florida not-for-profit (IRC Section 501(c)(4)) corporation established under Chapter 617, Florida Statutes, and regulated under Chapter 641, Florida Statutes. AvMed’s Mission, “To help our members live healthier,” and Vision, “To be our members’ trusted health partner for life,” is achieved through serving 280,000 members through underwritten and self-funded Commercial Groups, Individual Products and Medicare Advantage Plans. AvMed is headquartered in Miami, Florida, and also maintains regional offices in Ft. Lauderdale, Orlando, and Gainesville.

POSITION SUMMARY

The Associate Chief Medical Officer (CMO), VP Population Health has overall responsibility and accountability for effectively and efficiently leveraging technology and people in delivering a unique and differentiating member health and wellness experience. He/she shall have overall accountability for the medical and quality performance for all of AvMed’s product lines.

• This is accomplished through leadership of and operational responsibility for the following core Population Health functions: Care Management (includes prior authorizations, inpatient case management, transitional case management, and complex case management); Wellness strategy and program deployment; Quality and Accreditation including HEDIS and Stars; Credentialing; and Disease Management. This person will interpret and analyze key drivers of medical cost/utilization trends identifying opportunities to improve processes to address findings; and will work collaboratively with Pharmacy Director on pharmacy cost and utilization trends, Provider Alliances on contracting and value based strategy as well as with AvMed’s senior leadership team in fully understanding, accurately interpreting and predicting, and developing actions related to medical and pharmacy costs/utilization. Provides leadership and input for all plan quality improvement projects, with particular emphasis on the CMS Stars Rating program specific to the Medicare product. Strategic leader for all AvMed’s Stars related activities, including providing senior leadership to AvMed’s Team Lead structure; Team Leads include Directors from Quality, Pharmacy, Network, Sales, Member Engagement, and Compliance. Insures coordination of all Stars activity across all areas to achieve AvMed’s corporate goals. In addition to the Medicare Stars Program, provides leadership and input for quality improvement projects applicable to the NCQA accreditation of all product lines, with an emphasis on HEDIS, CAHPS, and HOS.



The success of the Associate CMO –will be measured by his/her ability to lead these critical functions within the Member Health and Wellness organization and in realizing AvMed’s mission, vision, values, core beliefs, and in particular, service philosophy, “We create peace of mind by inspiring confidence and building trust through everything we do” and aligned with the following guiding principles:
• The member is the customer;
• We will attract, engage, manage and retain our members across the health care continuum; and
• Engage aligned providers to deliver the optimal health and wellness experience.

KEY REPORTING RELATIONSHIPS

The Associate CMO – VP, Population Health reports to the:

• Chief Medical Officer (CMO)/SVP; and
• Works in unified and cohesive collaboration with the Plan President, Senior Vice Presidents, and other members of the leadership team responsible for AvMed’s core and enabling functions, as follows:
• Core Functions – Marketing & Sales to include the Member Experience, Product Life Cycle Management (PLM) & Innovation and Health Care Analytics; Provider Strategy & Alliances; and Delivery Solutions;
• Enabling Functions – Finance & Treasury Services; Information Technology; Human Resources; and Legal & Compliance.

Reporting to the Associate CMO/VP –Population Health are:

• Vice-President of Care Management
• Regional Medical Director (2)
• Director, Quality and Accreditation and Wellness
• Executive Assistant II

There are approximately 85 associates in these areas.

PRINCIPAL ACCOUNTIBILITIES

Member Experience

• Ensure optimal member (and aligned provider) experience through Member Health and Wellness
• Responsible for the design and implementation of Member Wellness programs that result in members actively engaged in their health; coordinate with PLM & Innovation.
• Ensure that Care Management and Quality areas facilitate members receipt of necessary medical and pharmacy services in a supportive environment that does not solely present barriers to care (simple and easy)

Associate Experience

• Instill and motivate a broader cultural desire across the organization to focus on the member, with the objective of consistently improving member (and aligned provider) experience metrics for Member Health and Wellness
• In collaboration with CMO and SVP-HR, responsible for Leadership Development and Talent Management of Member Health and Wellness associates, including establishing a leadership climate that contributes to a highly engaged and diverse workforce committed to AvMed’s Vision, Mission, Values, Core Beliefs, Service Philosophy, and Service Standards.
• Collaborate with AvMed Human Resources in the design, implementation, and maintenance of an effective AvMed associate Wellness program.

Business Operations and Results

• Responsible for achieving clinical quality targets and medical care cost/utilization goals, including development, implementation, and maintenance of action plans initiatives that will improve quality of care and improve medical cost of care.
• Provide the direction to improve the Company’s competitive medical cost position. Provide creative direction to achieve and enhance operational and medical care delivery efficiencies.
• Accountable for the development and implementation of medical and quality of care policies.
• Achieve and maintain NCQA accreditation, with goal of excellent, Medicare Star result of 4.0 or higher and Commercial NCQA rating of 4.0 or higher
• Provide leadership, direction and oversight of Complex Case Management, Disease Management, Utilization Management, Transitional Case Management, Quality, Wellness and Credentialing operations.
• Work collaboratively with Provider Alliances to execute shared initiatives including P4P, correct coding initiatives, provider performance metrics and clinical criteria for contracting.
• Execute shared initiatives around medical care costs with Provider Strategy & Alliances.
• Represent AvMed externally with providers and other constituents
• Responsible for developing and maintaining strong relationships and credibility with key constituencies, including our aligned providers.
• Responsible for leading and developing staff competencies aligned with the Company’s key financial and strategic priorities and its short and long term goals.
• Ensure collaboration and integration of Provider key strategies and Member Health and Wellness initiatives
• Oversee and ensure that Member Health and Wellness has the proper technology and operational systems and controls, administrative and reporting procedures, and talent processes in place.
• Work collaboratively with the CMO & CIO in ensuring all Member Health and Wellness technology and business applications are maintained and upgraded in accordance with IT standards, including version control, etc.
• Develop and maintain strong relationships with all key vendors that support Member Health and Wellness, while holding vendors accountable for delivering upon their contractual commitments.
• Review, approve and manage the Member Health and Wellness annual operating and capital budgets within industry standards and best practices in order to maintain an affordable and efficient cost structure.
• Monitor and manage monthly financial and other key performance metrics.
• Work in collaboration with CMO and other senior executives to achieve the strategic and operational objectives of AvMed.
• Act as Committee Chair for various quality committees, including the Provider Quality Improvement Committee (PQIC), the Corporate Quality Improvement Committee and the Stars and Quality Action Plan Committee

Executive Leadership

• Overall responsibility and accountability for organizational leadership and performance within Member Health and Wellness
• Work in collaboration with leadership peers to develop, implement and achieve the strategic, operational and financial objectives.
• As a key executive, take a proactive and engaged role in the identification and conversion of prospective members and clients.
• Represent AvMed externally and convey a professional and positive image.
• Participate on the President’s Strategy and Operations Councils and participate in other Strategic and Operational Committees, as appropriate, for carrying out organizational strategic plans, operations and policies.

Corporate Assurance & Compliance

• In collaboration with Chief Assurance Executive, Chief Compliance Officer and Director of Financial Controls, ensure effective corporate assurance, risk management, compliance functions and financial controls within Member Health and Wellness
• Ensure Member Health and Wellness meets all applicable regulatory, statutory and compliance rules and regulations.
• Ensure Member Health and Wellness meets all applicable accreditation requirements.
• Fulfill role of clinical liaison with accreditation and regulatory agencies.

Community and Industry Involvement

• Maintain a visible leadership role in appropriate Industry, Professional and Community organizations.
• As appropriate, represent AvMed externally to clients, providers, regulators and other constituents as relates to Member Health and Wellness
•
Policies and Procedures

• Ensure policies, procedures, rules and regulations necessary and desirable for the proper conduct of ordinary affairs of Member Health and Wellness are established, maintained and followed.

Other

• Perform other related duties as assigned by the CMO or President & COO.


KEY QUALIFICATIONS

Mission Driven - Alignment with the AvMed mission, vision, values, core beliefs, service philosophy and standards.

Florida Medical Licensure -Unrestricted and in good standing.

Education –Medical degree (MD) required. Master’s MBA/MHA/MS degree or equivalent experience preferred.

Experience – At least five years’ experience in active clinical practice and board certification in ABMS recognized specialty. Minimum of five (5) years’ experience in a complex and diversified health care/health insurance company; preferably with a minimum of two (2) years at a leadership level. Knowledge of Florida managed care market preferred.

Knowledge of medical cost analytics, provider risk and capitation contracting, including Medicare Advantage preferred.

Permanent Residence – Miami, Florida

CORE COMPETENCIES


Steward of the Business – Drives AvMed’s Strategy and owns the business. Clear understanding of organization, industry, constituents, and competitive markets. Sound business judgment. Service excellence mindset.

Delivers Results – Delivers strong business results. Sets and achieves challenging goals. Contributes towards achievement of corporate objectives. Cultivates a culture of accountability and sense of urgency.

Leadership Excellence – Sets the example for living The AvMed Way. Proactively shapes the desired organizational culture. Inspires, appreciates, and empowers others. High emotional intelligence.

Communication and Influence – Communicates clearly and confidently. Listens, writes, and speaks effectively. Shares important information. Motivates action and commitment.

Leads Change – Inspires, leads, and executes organizational change. Continuously challenges the status quo. Role models adaptability. Gains buy-in for change efforts.

Strategic Perspective – Thinks “big picture.” Understands broader context of the business. Anticipates what’s ahead. Recognizes how leadership role drives organizational objectives.

Maximizes Effectiveness – Helps others perform at their best. Builds a high performing team. Proactively engages and retains staff. Strong, positive relationships with others.

Time:  Full time
Salary:  Salary
Category:  Operations

Updated: 2/15/2019 10:30:04 AM