HealthPartners is currently hiring for a Health Plan Chief Medical Officer. We are a nonprofit integrated care delivery and financing system based in Bloomington, MN. At HealthPartners, you’ll find a culture where we live our values of excellence, compassion, integrity, and partnership. By working together, we will improve health and well-being, create exceptional experiences for those we serve and make care and coverage more affordable. We seek colleagues who wish to help advance diversity, equity and inclusion and foster an environment where everyone feels welcome, included, and valued.
The HealthPartners Health Plan Chief Medical Officer reports directly to the President & CEO, HealthPartners and is accountable for the medical oversight of our health plan to ensure the delivery of high quality, evidence-based, cost-effective medical services and care to our members and patients while contributing to growth and financial sustainability for the organization. This includes engaging in medical and pharmacy coverage policies and benefit design, new products and services, network relationships, and development of health plan growth strategies. This position will support and assure effective working connections across the organization to realize the full potential of combined organizational capabilities, develop new capabilities, and provide strategic leadership to build effective partnerships with contracted providers.
In collaboration with the HealthPartners executive leadership team the Health Plan Chief Medical Officer leads the development of long-term goals for better health and wellbeing for the people served by HealthPartners, affordability of healthcare and coverage as well as supporting internal and external relationships built on trust. The position is responsible for maintaining relationships with regulatory agencies, both state and federal, regarding medical aspects of the health plan and has final and ultimate decision-making responsibilities regarding medical matters for the Health Plan and ensures medical policies are consistent with NCQA and other regulatory accreditation bodies. The position is also responsible for maintaining visibility and involvement in the medical community including Minnesota Community Measurement and organizations nationally, regionally, and state-wide to further goals of improving health, enhancing member experience, and effectively managing cost.
- Medical Doctor with an active, unrestricted Minnesota medical license.
- Minimum of five (5) years’ experience as a health plan medical director with increasingly responsible assignments.
- Minimum of five (5) years of clinical practice experience.
- Proficiency with principals of insurance, managed care, evidence-based practice, and medical policy with a philosophy of collaboration and teamwork
- Knowledge and experience in principals of population health improvement and quality improvement required.
- Excellent interpersonal skills (negotiation, listening and communication skills) characterized by effective interaction with a diverse range of internal and external constituents, stakeholders, affected parties, and audiences.
- Demonstrated financial acumen and experience with quantitative financial and clinical results, strategic review, critical thinking, and decision-making skills
- Ability to build effective partnerships and influence other leaders and interface with functions at all levels within the organization
- Excellent management skills and the ability to coach and mentor staff.
- Ability to be a leader in health policy and community affairs.
- Ten (10) years of experience with direct patient care strongly preferred.
- Advanced Degree in Health Administration, Business Management or Public Health.
- Medical Specialty Board Certification
- Experience in developing organizational structure, policies, and practice and in the operations of Health Services, Medical Management, Disease Management, Quality, Pharmacy, Behavioral Health, and Appeals and Grievance departments
- Strategy & Leadership:
- Contribute as part of the executive leadership team in strategic planning to achieve mission, vision, and our business goals.
- Actively engages in understanding and communicating industry trends, marketplace dynamics, and government relations and promotes practice of evidenced-based medicine and population health.
- Translate and share learnings from interactions with external audiences to identify opportunities specific to innovation, growth and financial success of the organization and facilitate initiatives internally.
- Provide strategic leadership in partnership with other senior leaders to develop programs and initiatives that improve the quality, efficiency, service and affordability of care and coverage for HealthPartners plan members in individual, commercial, Medicare and State and public programs.
- Provide strategic leadership to build effective partnerships with contracted care systems across the region, including design of payment approaches to promote delivery of cost-effective, evidence-based medical services.
- In partnership with SVP, Chief Health Engagement and Analytics Officer, leads efforts to design HealthPartners for Better Health goals and ensure execution as reported to the HealthPartners Board of Directors.
- Medical/Utilization/Quality Management:
- Provide senior medical leadership and direction for HealthPartners health plan in areas of utilization/cost management, clinical quality improvement, and medical policy development This includes oversight of Complex Coverage Issues and support of member appeals reviews.
- Leads and supports development of quality and utilization programs including review of utilization reporting to identify areas for improving utilization management and provider contracting.
- Assume a leadership role with other peer Chief Medical Officers to influence management of quality and clinical outcomes regionally and nationally.
- Team Oversight and Operational Partnerships:
- Responsible for hiring, managing, and leading the health plan medical director team and providing strategic support and leadership for the physical and behavioral health service activities of the Associate Medical Directors and their dyad functional directors and managers for utilization management, case management, quality improvement, provider contracting, provider relations, health initiatives, commercial customers, and physician services.
- Provides strategic support and leadership for quality including oversight of Chief Quality Officer in partnership with the Chief Operating Officer of the Care Group.
- Attend board meetings and provides staff support to the HealthPartners’ Board of Directors Quality Committee, Member Appeals Committee and other board duties as assigned.
- Manage annual budget for the department and collaborates with executive leadership to achieve annual financial goals of the organization
- External Relationships:
- Serve as local and national spokesperson and thought leader on HealthPartners strategies and vision, and acts as an ambassador in the community.
- Responsible for maintaining visibility and involvement in the medical community including organizations such as: Americas Health Insurance Plans, Minnesota Community Measurement, and Alliance of Community Health Plans.
- Build and maintain effective relationships with a wide range of constituencies and stakeholders, including, but not limited to, employers, plan members, brokers, providers, system leaders, board members, other healthcare organizations, government and regulatory bodies and others in the community.
HealthPartners is recognized nationally for providing outstanding care and experience for patients and members. We offer an excellent salary and benefits package. For more information and to apply go to www.healthpartners.com/careers and search for Job ID # 68582.