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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates extensive clinical leadership and strategic direction in healthcare delivery, with a strong focus on population health management, quality improvement, and compliance with regulatory standards. Possesses a deep understanding of healthcare financing and the ability to foster relationships with physicians and clinical teams to enhance provider performance.
Highest-signal resume keywords
MD Or D.O. DegreeBoard CertificationMedicare Advantage ExperiencePopulation Health ManagementClinical Leadership
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical Operations ManagementMedical Cost ManagementUtilization ReviewQuality Management ProgramsHealthcare Financing KnowledgeEvidence-Based Care InitiativesProgram LeadershipClinical Program DevelopmentRisk ManagementContinuous Quality Improvement
Soft Skills
Excellent CommunicationProblem-Solving SkillsRelationship BuildingCoaching and MentoringMotivational Leadership
Certifications & Qualifications
Current Unrestricted Medical License
Industry Keywords
Managed CareHealth PlanCapitated ProviderPopulation HealthValue-Based ContractsCMS ComplianceNCQA StandardsHealthcare DeliveryClinical StrategyAccountable Care
About the role
Key responsibilities & impact- Provide strategic direction and clinical expertise to guide policy, programs, and overall healthcare delivery
- Serve as a clinical operations leader and clinical lead for Essence Healthcare
- Oversee, coach, mentor, motivate, support, and develop a cross-functional team of seasoned people leaders
- Oversee and coordinate clinical aspects of the health plan, including medical and pharmacy management, utilization review, and evidence-based care initiatives
- Manage medical costs
- Plan and facilitate medical director meetings
- Foster relationships with Essence physicians and partner with medical groups on provider performance management
- Align physician incentives, quality measures, and value-based contracts
- Maintain relationships with ARO Value Based Care Enablement CMOs and clinical teams at partnering organizations
- Direct and monitor medical management activities and quality management programs for compliance with CMS, NCQA, and other accrediting bodies
- Collaborate with the Corporate Chief Medical Officer on clinical strategy, design, communications, and risk management
- Act as an internal consultant on clinical program development and special projects for Lumeris customers
- Support the Accountable Delivery Systems Institute on accountable care, physician engagement/alignment, payer and clinical transformation, and technology-enabled care models
- Contribute to clinical thought leadership through presentations, case studies, and scientific articles
Requirements
What you’ll need- MD. or D.O. degree, plus Board Certification
- Current, unrestricted medical license
- 15+ years of relevant experience or the knowledge, skills, and abilities to succeed in the role
- 7+ years of people, program, or project leadership experience or the knowledge, skills, and abilities to succeed in the role
- Demonstrated experience in a successful clinical practice
- Substantial Medicare Advantage experience
- Proven health system, health plan or capitated provider experience with exposure to managing total cost of care, quality, and documentation and coding
- Deep understanding of population health & managed care
- Strong background in administrative clinical leadership
- Solid understanding and experience with population health management strategies
- Knowledge of healthcare financing and the relation to various managed care products (HMO, PPO, Indemnity, and Medicare Advantage)
- Knowledge of continuous quality improvement theory and practice
- Excellent communication and problem-solving skills
- Demonstrated track record of developing productive working relationships internally and externally at all levels
- Expert ability to positively impact results
- Authorized to work in the United States; visa sponsorship unavailable
Benefits
Comp & perks- Medical, Vision and Dental Plans
- Tax-Advantage Savings Accounts (FSA & HSA)
- Life Insurance and Disability Insurance
- Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days)
- Employee Assistance Program
- 401k with company match
- Employee Resource Groups
- Employee Discount Program
- Learning and Development Opportunities
- Performance-based incentive and/or equity may apply to eligible roles