JOB SUMMARY:
The Chief Medical Officer (CMO) reports directly to the Commission on medically related matters and to the Chief Executive Officer on all other matters. The CMO is primarily responsible to carry out the medical planning and management functions for the Fresno-Kings-Madera Regional Health Authority (RHA) by performing duties personally or through the management of subordinate staff. The CMO will provide leadership on medical issues affecting the organization. The work is varied and highly complex requiring a high degree of discretion and independent judgment.
The CMO position is an at-will classification unless otherwise provided for in an employment contract.
ESSENTIAL DUTIES & RESPONSIBILITIES:
- Ensures that medical care rendered by providers meets with applicable professional standards for acceptable medical care and quality that equals or exceeds the standards for medical practice developed by the RHA and approved by the State Department of Health Care Services.
- Develops and implements medical policies for the RHA.
- Monitors the availability and accessibility of services.
- Ensures that medical decisions by the RHA, and the RHA administrative services provider, are rendered by qualified medical personnel, unhindered by fiscal or administrative management.
- Coordinates professional interactions among participating providers and lends guidance and assistance toward correcting any deviation from medical standards.
- Monitors and resolves medically-related grievances/appeals that flow through the Member Grievance Process.
- Serves as chairperson of the Quality Improvement/Utilization Management Committee and the Peer Review/Credentialing Sub Committee.
- Provides medical direction and supervision of all compliance audits, reviews, and assessment of delegated administrative services.
- Maintains a formal Quality Improvement Program for the RHA, its administrative services provider, and participating health care providers.
- Serves as a liaison between the RHA and direct contracting providers and providers contracting through the RHA’s administrative services provider.
- Resolves provider claims grievances involving medical matters.
- Ensures the privacy and security of PHI (Protected Health Information) as outlined in RHA’s policies and procedures relating to HIPAA compliance.
- Required to travel within US at the direction of the Commission.
- Other duties as required.
MINIMUM QUALIFICATIONS:
EDUCATION:
- Medical Degree from an accredited medical school
- Satisfactory completion of an accredited residency program, Board Certification preferred
- License to practice medicine in California
EXPERIENCE:
- At least five years clinical experience in the practice of medicine in fields related to a managed care setting.
- At least five years clinical experience in the practice of medicine with Medi-Cal and/or Medicare populations.
- Two or more years of medical administrative experience.
KNOWLEDGE, SKILLS & ABILITIES:
- Administrative practices and procedures (including but not limited to quality assessment and improvement, utilization review, peer review, credentialing, health plan member grievances, and risk management.
- Rules, regulations, policies, and standards related to managed care.
- Principles of effective supervision and organization.
- Methods, techniques, practices, principles, and literature in the broad field of medical sciences.
- Overview of the highly specialized techniques, procedures, and equipment used in the medical or surgical specialties.
- Strong skills in identifying, planning, leading, and executing appropriate and successful health care business strategies to meet changing organizational and community needs and regulatory requirements.
PHYSICAL REQUIREMENTS:
- Constant and close visual work at desk or computer
- Extensive typing
- Constant sitting and working at desk
- Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person
- Frequent walking and standing
- Frequent lifting of folders, files, binders and other objects weighing between 0 and 30 lbs
- Must have reliable transportation, may be required to travel between Kings, Madera and Fresno counties as well as between offices for meetings
NOTE: The information in this position description indicates the general nature and level of work performed by employees within this classification. It is not designed to be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of employees assigned to this job.
CalViva Health is the Local Initiative Plan for Fresno, Kings and Madera Counties. CalViva Health is under the Medi-Cal Managed Care Program. It is sponsored by the Regional Health Authority, which offers local access, local control and local responsive health care.
