20 days old

Chief Medical Officer / Chief Health Officer

Oklahoma Health Care Authority
Oklahoma City, Oklahoma 73105
  • Job Type
    Employee
  • Job Status
    Full Time

Chief Medical Officer / Chief Health Officer

The Oklahoma Health Care Authority (OHCA) is the State Medicaid Agency of the State of Oklahoma. OHCA is searching for a Chief Medical Officer / Chief Health Officer.

As an Executive Leadership Team member, this position will work in conjunction with the CEO and the Executive Leadership Team to strategically plan and collaboratively guide the overall management and operation of the Oklahoma Health Care Authority Agency.

The selected individual will direct the Medical Professional Services division, consisting of multiple agency departments, which includes the Medical Authorization & Review (MAR), Quality Assurance/Quality Improvement (QA/QI), Medical Administrative Support Services (MASS), and the Medical/Dental section. Will be consistent with state leadership and agency goals focused on health care delivery, innovation and payment reform to improve outcomes, contain costs and ensure program accountability and sustainability.

DUTIES INCLUDE THE FOLLOWING:

As a member of the Executive Committee and the Operations team, this position provides regular input regarding the potential impact of policy and operational decisions on the delivery of quality health care to members and providers.

Provides coaching and direction to the Medical Directors, consultants etc. who are responsible for a wide variety of activities including determinations of medical necessity including prior authorization, legal appeals, approval or denial of out of state services, review of private duty nursing, and developing, communicating and recommending agency policy and guidelines to providers to meet the agency goal of providing access to and delivery of quality health care.

Emphasizes and promotes best practices in utilization management through the establishment of a robust utilization management program. Uses evidence-based decision-making to ensure Medical processes are carried out in an efficient and effective manner.

Facilitates frequent ongoing communication and interactions among the Medical Professional Services departments, as well as other areas, such as Population Care Management, Legal, Provider Contracting, Program Integrity, Policy, Finance, Provider Services, Business Enterprises and Behavioral Health etc. as is appropriate for the accomplishment of agency goals.

Coaching and support to the Directors of DMEPoS, Psychologists and Behavioral Health to assist them in efficient operation of their programs, and QI/QA, Medical Home/Health Access Network audit and review and Clinical Coding/Reference File and Post payment review. Coordinate requests for data analysis to the geneticist/medical data analyst.

Provide clinical direction for changes and modifications to the Clinical Claims editing system and reference file and to projects involving MMIS modifications, Fraud & Abuse, ICD-10 implementation and the MMIS re-procurement.

Prioritizing quality outcomes by providing administrative leadership to the Chief Quality Officer. Consult with and support the QI manager in overseeing the EQRO contract including the provider Education/Intervention Committee, Quality Reports, studies etc. Promotes and designs quality strategies to address social determinants of health.

Oversee and support the audit process for reviewing and improving the Medical Home contracts and education process. Provide support and recommendations for further development of the Medical Home and Health Access Networks.

  Complete special projects as assigned such as legislative task forces, internal work groups, represent the agency and deliver presentations at local and national meetings. Participate in annual strategic planning meetings with other partners.

Requirements

REQUIREMENTS:

CHIEF MEDICAL OFFICER

    Medical Degree (MD or DO) from an accredited school of medicine recognized by national regulatory bodies in the US

    Minimum of 5-10 years of post -graduate experience in direct patient care with progressively more responsibility in a health care setting

    Be board certified by an appropriate specialty college or program (or DO equivalent)

    Three (3) years of medical management or supervisory experience as a medical professional

    Current active state license with DEA privileges; if not fully licensed in OK, must complete licensing in OK within 6 months of hire

    Must remain up to date with annual continuing education requirements

    Capable of effectively communicating and motivating associates at all levels of the organization

CHIEF HEALTH OFFICER

   Master’s Degree or higher from an accredited university

    Minimum of 10 years of post -graduate experience in health care administration

    Minimum of 5 years management and/or supervisory experience

    Capable of effectively communicating and motivating associates at all levels of the organization

    Experience in implementing utilization and quality improvement strategies/techniques and experience with physician behavior modification

    Experience in developing medical policy, procedures and programs

APPLY TO:

dara.holmes@okhca.org

Categories

Posted: 2021-12-29 Expires: 2022-01-28

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Chief Medical Officer / Chief Health Officer

Oklahoma Health Care Authority
Oklahoma City, Oklahoma 73105

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