Health Alliance and Carle Health System in Champaign, Illinois seek an experienced physician executive to serve as Associate Chief Medical Officer for Health Alliance. This is an outstanding opportunity to join an expanding health plan within Carle Health, one of the region's leading integrated healthcare delivery systems. Health Alliance is a growing physician led health plan serving Illinois, Iowa, Indiana, Ohio, North Carolina and the state of Washington with over 240,000 members. The health plan is committed to value and the promotion of progressive care models to deliver excellent patient care outcomes to its members. With a proven customer-driven performance reputation, Health Alliance rated 4 out of 5 Stars nationally for our Medicare Advantage HMO/POS plan in Illinois and 5 out of 5 Stars for our Stand Alone Prescription Drug Plan.
The Associate Chief Medical Officer is a vital member of health plan operations and the executive leadership team to provide primary physician leadership and direction for Health Alliance. Health Alliance seeks an experienced medical executive with the clinical context to provide strong leadership, accountability, credibility and mentorship of colleagues on the journey from volume to value based care.
The Associate Chief Medical Officer will report directly to the Chief Medical Officer, Health Alliance. This person will have direct oversite of the Medical Directors, with a heavy emphasis on utilization management and data analytics, for Health Alliance. The ACMO will possess outstanding interpersonal skills with the ability to communicate effectively and build consensus to achieve objectives. The ACMO will participate, as directed by the CMO, in operationalizing the Health Alliance strategic plan.
M.D. or D.O. from an accredited medical school. Board certification, current active licensure and eligibility for licensure in the state of Illinois.
Physician leadership coursework or Master's degree in Business, Health Administration, or Public Administration is recommended.
Ten years of medical practice with progressive administrative leadership.
Experience and Skills:
Extensive knowledge and experience with health plans including utilization management, policy and claim review, and deep understanding and interest in medical economics and data analysis.
Results oriented with the demonstrated ability to develop and operationalize policies across the health plan to improve performance and workflow.
Strong understanding and experience examining appeals and case reviews for claim denials that promote consistency across the organization.
Engage key internal stakeholders to review processes and ensure coordination across the health plan.
Ensure the application of best practices, incorporating regulatory requirements at the local, state and national level.
Provide evaluation, professional growth, development and mentoring for experienced team of medical directors.
A level of financial acumen to understand the requirements of financial risk models throughout the transition, from "fee for service," to value based payment as well as potential financial impact and opportunities when reviewing claims and denials.
Ability to function effectively and comfortably in a matrix environment in which there are multiple collaborative organizations with some shared goals within complex lines of authority and responsibility.
Familiarity and passion for analytics as it relates to utilization manage, cost analysis, population health management and the impact of data in the continuous assessment and monitoring that strives to improve care and service provided to members.
Ability to utilize clinical patient care practice experience to examine complex member issues and challenges as brought forth by medical directors and review committees.
Excellent listener and communicator with demonstrated track-record in fostering collaboration and building consensus to achieve collective objectives.
An open and accessible style, is calm and thoughtful, encourages input from the team. A consensus builder with superb facilitation skills, a team player who is collaborative and possess the highest level of integrity.
Internal Number: 2.12
About Carle Health/Health Alliance
Based in Urbana, IL, The Carle Foundation is a vertically integrated system with more than 9,500 employees in its five hospitals, multi-specialty physician groups, health plan and associated healthcare businesses including the Carle Illinois College of Medicine, the world’s first engineering-based medical school. Carle is proud to be named a Great Place to Work®. Carle Foundation Hospital and Carle BroMenn Medical Center hold Magnet® designation, the nation’s highest honor for nursing care and Carle Foundation Hospital (CFH) ranks as one of America’s 50 Best Hospitals™ by Healthgrades®.