Chief Medical Officer, MCC

United States

Job Description

Responsible for setting the strategic vision, comprehensive medical policy and clinical operating plan for Magellan Complete Care (MCC), an organization whose sole mission is to support the needs of complex populations with physical, behavioral and social determinants of health challenges. Works collaboratively with the president of MCC and the MCC senior leadership team to achieve overall company goals of growth, financial performance and margin sustainability, industry thought leadership and clinical quality improvement. Overall accountability for MCC cost of care management. Responsible for clinical oversight of medical policy, utilization management and formulary management in accordance with evidence based criteria and state/federal guidelines and leads the development of clinical programs and population health initiatives for MCC nationally, as well as the integration of physical and behavioral health operations, while providing input to value-based payment partnerships with our provider partners. Serves as the primary medical representative on behalf of the MCC national organization internally and externally and participates in business development opportunities, provider partnership discussions and trade association policy leadership. Directly responsible for overseeing medical policy for Medicaid and Medicare, utilization management, population health, care management standardization for all populations (including long term services and supports), behavioral health and pharmacy.
  • Works closely with the MCC clinical and medical team to create and implement national medical and clinical policy and programs.
  • Manages Medical Directors in providing cost-effective and quality care management services. Interfaces with National and State medical leadership, both in standing meetings and as needed, to discuss emerging issues, improvement in metrics, and strategic plans.
  • Provides medical leadership, oversight, consultation and supervision for the MCC (QI) Program, Pharmacy Program and Utilization Management (UM) Program.
  • Provides strategic direction and implementation assistance for Disease and Care Management programs nationally.
  • Identifies clinical trends and best practices and partners with Clinical leadership and other cross functional teams to develop and adopt said best practices to improve the clinical and cost effectiveness of member services. This includes working with the Network and Quality leadership to develop and deploy best practice value-based purchasing efforts.
  • Develops, implements and interprets medical/ clinical policy for MCC (including Medical Necessity Criteria, Clinical Practice Guidelines and New Technology Assessments). This includes ensuring that the medical directors are applying the medical/clinical policies to their respective areas of oversight.
  • Ensures effective deployment of medical and clinical resources and consistency across the health plans, ensuring that critical functions are developed and deployed as specific needs arise.
  • Drives to resolve short term, cross functional issues adversely impacting clinical outcomes.
  • Leads clinical program development across MCC; implementation and interpretation of clinical and medical policies and procedures; national and local Physician recruitment; national provider profile design and interpretation.
  • Oversees all utilization management, care management, disease management and quality management activities; continuous assessment and improvement of the quality of care provided to behavioral health recipients; and development and implementation of the National and Local QM and UM plans.
  • Develops, mentors Director or matrixed Medical Directors. Marketing / communication collaboration/client engagement and RFP content support.
  • Develops and maintains documentation about the programs and products.
  • Serves as a key knowledge resource on complex care across the organization.
  • Works with Matrix Partners (Finance, Legal, Regulatory and Compliance, Corporate Audit, Human Resources).
  • Oversees the management of all levels of Medical Directors serving the health plans.
  • Manages the work of local Medical Directors in providing cost-effective and quality care management services.
  • Engages in Utilization Management (UM) and Care Management (CM) activities, including case reviews and UM decisions, including appeals.
  • Responsible for cost of care of health plans, including reviewing data, interpreting data, and applying data for operational and cost of care interventions.
  • Participates in the RFP process for new business opportunities in the region.
  • Provides overall clinical construct and direction for RFP Responses for the designated business unit region to ensure the clinical integrity of serving complex populations.

General Job Information

Title

Chief Medical Officer, MCC

Grade

37

Job Family

Clinical Services Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

8/1/2019

Date Requisition Created

8/1/2019

Work Experience

Medical

Education

Masters: Business Administration (Required), MD (Required)

License and Certifications - Required

DO - Physician, State Licensure and Board Certified (ABMS or Specialty Board) - Physician, MD - Physician, State Licensure and Board Certified (ABMS or Specialty Board) - Physician

License and Certifications - Preferred

PharmD - Doctor Of Pharmacy, State Licensure - Pharmacy, RPH - Registered Pharmacist - Pharmacy

Other Job Requirements

Responsibilities

15+ years as a senior leader in managed care, working with primary care and specialty physicians, medical facilities and medical management issues, physicians practicing in groups, government sponsored product lines, media relations and managed care marketplaces.

Knowledge and experience implementing successful growth strategies. A passion to serve the "duals" population; understands specialty population risk management, risk stratification and product design. Experience developing innovative product strategies. Strong long-term relationships with key industry customers. Experience developing and directing high-performing teams. Comfort and skill leading in a highly matrixed organization. Demonstrated ability to market appropriate, innovative clinical products that differentiate Magellan Clinical performance and achievement of cost of care goals from competitors. Quality outcomes. Recognized, respected clinical presence in the US healthcare marketplace. Enterprise-wide Leadership: Strong, positive, collaborative relationship with senior leadership team across all of Magellan's product lines, demonstrated leadership team effectiveness, and an engaged/committed workforce.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

“I receive a high level of support from our Senior Management Team to execute on our vision. They are always accessible and approachable, something I’ve found to be very unique to Magellan.”