Chief Medical Officer

Description

CHIEF Medical OFFICER (CMO)

The Centerfor Elders'Independenceis a PACE (Program of All- Inclusive Care for the Elderly) organization that uses an interdisciplinaryteam approach tocare planning and care implementation for the purpose of providing high quality, affordable, integrated health care services to theelderly, including an Adult Day Health Center, and promoting autonomy, quality of life and the ability of individuals to live in their communities.

The Position: Under the direction of the Chief Executive Officer (CEO), the Chief Medical Officer (CMO)provides strategic and operational medical leadership to CEI. The CMO is accountable forensuring the quality, safety, and effectiveness of participant care; clinical outcomes; regulatory compliance; and leadership of CEI’s Quality Assessment and Performance Improvement (QAPI) program.The CMO is responsible for providing executive level leadership in the provision of medical services at CEI to include evidence-based participant centered care through the interdisciplinary model and value based care strategiesThe CMO is responsible for medical policy, decision-making, and oversight of all medical affairs, including participant care, utilization management, quality management, and credentialing.The CMO fosters collaboration with leadership and among providers, oversees clinical quality improvement initiatives, and represents the organization with regulators, community stakeholders, and the Board of Directors.

COMPETENCIES:

• Conflict Management

• Facilitates Change/Growth Mindset

• Professionalism

• Decisiveness & Problem Solving

• Sound Knowledge of Value-Based Care Principles
• Health Equity & Culturally Responsive Care

DUTIESANDRESPONSIBILITIES:

Medical Leadership

• Provides overall leadership and oversight of all CEI physicians,nurse practitioners, and contracted medical providersincluding hiring, credentialing, supervision, performance management,and professional development.
• Evaluates and improves medical service delivery embracing implementation of best practices for CEI and leads development of standards of care for CEI
• Responsible for the delivery of participant care and clinical outcomes.
• Review of pharmacy utilization, pharmacy reports and processes.
• Leadership/collaboration of the CEI care management (utilization management) program encompassing both pharmacy and comprehensive medical services. This includes establishing and maintaining evidence-based clinical criteria for appropriate use of diagnostic testing, specialty referrals, procedures, hospital admissions, and post-acute care services.
• Lead review processes for high-cost, high-frequency, or complex cases, monitor utilization trends, and identify patterns of overuse or underuse.
• Work closely with interdisciplinary teams to align care delivery with clinical best practices, reduce unnecessary variation, and improve participant outcomes.
• Oversees utilization management within a fully capitated, risk-based PACE model; including pharmacy, specialty care, hospitalizations, post-acute care, and long-term care services and supports; with a focus on quality, cost, and appropriate care.
• Collaborate with the CEI Executive Team to enhance organizational development, service delivery, and strategic initiatives.
• Ensures compliance with regulatory requirements, engaging providers in peer-to-peer case discussions and implementing corrective action plans when utilization concerns are identified.
• Oversee the orientation/onboarding of new providers to PACE standards and regulations.
• Provides direct participant care as needed.
• Maintain 24-hour call availability as Chief Medical Officer; when unavailable, delegate same.

Credentialing & Quality Management

• Establish credentialing and re-credentialing standards for medical providers.
• Implementation and oversight of CEI’s quality and performance improvement program (QAPI) in collaboration with Chief Operations Officer (COO) and Director of Quality Improvement.
• Direct and oversee clinical quality management, including determination of appropriate standards, identification and measurement of quality indicators, adverse event monitoring, root cause analysis, and performance improvement initiatives.
• Maintenance of medical policies and procedures, standards, and protocols to adhere to state and federal regulations.
• Adheres to and remains current with regulations.
• Leads or participates in various committees as requested

Network Development & Relationship Building

• Serve in a leadership role, in collaboration with the Chief Executive Officer, with the health care provider community, key community leaders as well as State and Federal entities to advance the CEIPACE program.
• Serve as an advocate for RMHCS and enhance the involvement of the provider community.
• Actively participates and collaborates among colleagues and providers in the community.
• Play a visible role in representing CEIin national and local forums.
• Represents CEI as the senior clinical leader in regional, state, and national forums, including collaboration with CalPACE and the National PACE Association (NPA).
• Build and maintain strong, professional relationships with other members of the Executive Leadership Team.
• Other duties as assigned.

QUALIFICATIONS:

Education

• Physician holding an M.D. or D.O. degree
• Must be licensed to practice medicine in California.
• A current and valid Drug Enforcement Agency Certificate.
• Formal training in Internal Medicine or family Practice preferred.
• Subspecialty training, or experience in Geriatrics and/or Palliative Care are highly desirable.
• Minimum of one year of experience with a frail elderly population

Background

• 5 - 10 plus years of progressive medical leadership experience (Medical Director, Associate Medical Director, or CMO)in a complex healthcare environment required.
• PACE, managed care, geriatrics, or value-based care leadership experience strongly preferred.
• Demonstrated experience leading interdisciplinary teams and quality improvement programs.
• Demonstrated commitment to health equity, culturally responsive care, and addressing social determinants of health impacting frail elder populations.
• Ability to lead, manage and prioritize change.
• Knowledge of the physical, mental and social needs of frail older adults.
• Effective skills in physical assessment and chronic disease management for frail older adults.
• Skill in use of data collection and analysis.
• Comprehensive working knowledge of healthcare improvement principles and techniques.
• Demonstrated excellent communication skills

The above jobdescription isintended tocommunicate thegeneral function of thementioned position and bynomeans shall be considered an exhaustive or complete outline of the specific tasks and functions that will be required.CEI reserves the right to change job descriptions,site assignments, and or work hours as required by the needs of theprogram.Allemployees are expected toperform their duties within their ability as required by the job and/or as requested by management.

September 20201

Center for Elders’ Independence is a PACE (Program of All- Inclusive Care for the Elderly) organization that uses an interdisciplinary team approach to care planning and care implementation for the purpose of providing high quality, affordable, integrated health care services to the elderly, including an Adult Day Health Center, and promoting autonomy, quality of life and the ability of individuals to live in their communities. Unlike other healthcare plans, CEI is not a "fee-for-service" plan. It is a “capitation” healthcare plan. CEI is paid a set amount for each person enrolled in our program, whether or not that individual seeks care. We are a growing company that offers stability and continues to thrive.