It’s Time For A Change…Your Future Evolves Here
Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.
Are we growing? Absolutely—56.7% in year-over-year revenue growth in 2016. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016 and 2017, and one of the “50 Great Places to Work” in 2017 by Washingtonian, and our CEO was number one on Glassdoor’s 2015 Highest-Rated CEOs for Small and Medium Companies. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.
What You’ll Be Doing:
Evolent Health is looking for the Health Plan CMO of a new Florida Medicaid provider sponsored network (PSN) health plan who is committed to removing barriers to care and keeping Floridians healthy.
The Chief Medical Officer is a key member of the Senior Leadership Team and serves as the clinical thought leader responsible for developing and executing strategies that both improves the quality of health care delivered to our members and improves cost and efficiency. The Chief Medical Officer will be directly responsible for managing an integrated clinical operation that includes utilization management, care management, population health, quality, and pharmacy management. The Chief Medical Officer will be responsible for all the clinical operations, and for establishing and maintaining clinical and medical policies that conform to optimal clinical practice standards. As a collaborative member of a team of nurses, social workers, physicians, pharmacists, health economists, and program coordinators, the CMO will have the opportunity to make a profound impact on the lives of our members.
As a Provider Sponsored Network (PSN), critical functions of the role include engaging the physician network, organizing physician-led clinical governance and culture, and providing medical direction on all provider network issues. The Chief Medical Officer will have responsibility for managing total cost of care using a collaborative, multi-disciplinary approach. This includes designing and executing clinical aspects of alternative payment programs that improve quality and lower costs, and includes managing operational aspects of all clinical programs.
The Health Plan leadership team, including the CMO, will have the added strength of working with the clinical, financial, analytics, and operational services of both Evolent Health and the primary provider PSN entity health system to support the local health plan needs and functions.
The Health Plan CMO will report directly to the Health Plan CEO-Market President and have a matrix reporting relationship to the Evolent National Medicaid Medical Executive as a member of the Evolent Medicaid Center of Excellence (MCoE) clinical leadership team.
Physician and provider relationship management
- Responsible leading change with physicians and other providers to improve the quality and efficiency of care in the network and integrate these providers into our clinical initiatives, including creating and maintaining a system that gives continuous feedback on these initiatives.
- Visits network facilities on a regular basis, identifies key issues facing leaders and works collaboratively with leadership to accomplish mutually agreed upon goals.
- Participates in the development of physician incentives, value based contracting arrangements, pay for performance and targeted network improvement programs.
- Partners with Evolent Health analytics to provide meaningful and actionable information to physicians.
- Lead and support activities related to communications, physician/provider engagement, and programming including outward facing membership growth and organizational visibility and success.
Population health – collaborative care management leadership
- Provides clinical leadership and development for population health programs or functional areas within Medical Management.
- Serves as a lead physician on the medical management team working closely with clinical and market leadership, in addition to providing direction for program development of the Medicaid line of business (LOB)
- Serves as the chairperson for the Physician Advisory Committee (PAC) and other physician-led committees
- Assists in assuring appropriate health care delivery for the assigned membership and managing the medical costs associated with the assigned population.
- Promotion of managed care systems using evidence-based medicine to educate and facilitate best practices with care management staff and medical physicians/providers
- Participates in Physician/Practice Meetings
- Responsible for executing and maintaining Evolent Health’s benchmarked Utilization/Cost Management Program and relevant Clinical Quality Improvement Programs
- Participates as needed as part of Evolent Health’s national UM Medical Director team to assure quality of care in all aspects of medical utilization and to assure that utilization is appropriate to meet the needs of the members and falls within recognized standards of efficiency
- Supports and leads, as needed, operational performance to develop and implement the health plan’s clinical guidelines and protocols that can be utilized through the quality improvement, utilization management, and case management processes to positively impact the delivery of care.
- Collaborates as needed with risk management, claim adjudication, pharmacy utilization management, catastrophic case review, outreach programs, HEDIS reporting, site visit review coordination, triage, provider orientation, etc.
Quality of care and service delivery
- Provides guidance and interpretation on issues of medical appropriateness, benefit application as appropriate, level of care necessary to include out-of-network care.
- Evaluates and ensures systems and processes to assist physicians/providers with adherence to evidence based protocols
- Assures compliance related to Federal (e.g., CMS), State (e.g., Insurance commission) and local rules and regulations.
- Works closely with community provider leaders to ensure accurate understanding of the Company’s mission and goals and quick response to any provider issues and questions regarding Company performance and progress.
- Identifies and implements other strategies that insure quality care, access to care, and the financial success of the Company.
The Experience You’ll Need (Required):
- Graduate of an accredited medical school. M.D. or D.O. MBA or a Master's Degree is preferred in healthcare, or other related fields of study.
- Active physician license without any restrictions.
- 10+ years of clinical practice in a primary care setting preferred and progressively responsible medical administrative experience.
- Board certification in ABMS recognized specialty
Finishing Touches (Preferred):
- Proven ability in medical leadership position possessing clinical credibility with peers and the ability to be a team player and team builder.
- A thorough understanding of all aspects of managed care, including HMOs, PHOs, risk arrangements, capitation, peer review, performance profiling, outcome management, care coordination, pharmacy management, and patient centered medical home concepts.
- Experience with population health management strategies and implementation
- Excellent interpersonal, verbal, and written communication skills.
- Ability to navigate in a corporate matrix environment.
Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.