Chief Medical Officer, Health Plan

Careers With Purpose Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint. Facility : GSS National Campus Location : Sioux Falls, SD Address : 4800 W 57th St, Sioux Falls, SD 57108, USA Shift : 8 Hours - Day Shifts Job Schedule : Full time Weekly Hours : 40.00 Job Summary The Chief Medical Officer is responsible for providing medical oversight, expertise and leadership to ensure the delivery of cost effective, quality healthcare services to health plan members. Reporting to the President and CEO of the health plan and collaborating with the senior leadership team within the plan and the system, the Chief Medical Officer will lead and directly manage the health plan’s key clinical teams and utilization review processes. Manages and leads Health Plan's medical directors, pharmacy team, and clinical operations team which includes utilization management, care management, population health, quality, risk adjustment and appeals and grievances. Serves as clinical advisor to and educator of medical management staff making sure correct clinical judgment is applied to all medical management determinations. Provide leadership and expertise in the development, implementation and interpretation of medical review and quality related policies and guidelines. Coordinate physician input and efforts to develop and coordinate clinical pathways, practice patterns, protocols and health insurance plans. Promote positive relations with the local medical community, including periodic consultation with providers or prescribers. Review case management data, identifies trends and gaps in care and recommends corrective actions. Review all quality of care issues and oversees the development and implementation of processes for improvement. Participate in and provide clinical expertise in data collection and analysis to achieve high-quality services and cost efficiency. Monitor performance indicators to ensure the delivery of cost-effective care within quality standards. Applies advanced technical knowledge of clinical medicine and the medical insurance industry to solve highly complex challenges. Ensure the delivery of safe, high-quality health care in accordance with enterprise mission, vision and strategic goals. Qualifications Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) required. Master's degree in business administration, population health, public health, or health care economics preferred. Minimum of three years of health plan / insurance experience preferred. Rural experience preferred. Must be licensed (or obtain license) to practice medicine in South Dakota or Wisconsin. Benefits Sanford Health offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work / life balance benefits, and a generous time off package to maintain a healthy home-work balance. For more information about Total Rewards, visit https : / / sanfordcareers.com / benefits . Sanford is an EEO / AA Employer M / F / Disability / Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to talentsanfordhealth.org . Sanford Health has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment. Req Number : R-0214043 Job Function : Leadership Featured : No