Chief Medical Officer
Posted on: 27 Jun 2021
Sunrise, FL
Job Description
Position purpose:
Provide medical oversight, expertise and leadership to ensure the delivery of cost effective, quality healthcare services to health plan members.
Provide leadership and expertise in the development, implementation and interpretation of medical review and quality related policies and guidelines.
Provide oversight and direction for staff and provider training and education.
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.
Monitor performance indicators to ensure the delivery of cost-effective care within quality standards.
Monitor member and provider satisfaction and recommends and implements changes to improve satisfaction levels.
Work collaboratively to develop corporate clinical care standards and medical practice policies.
Provide medical guidance to the Medical Management department.
Education/Experience:
Medical Doctor or Doctor of Osteopathy. 7+ years of clinical experience in the practice of medicine. Management experience preferred. Utilization management experience and knowledge of quality accreditation standards preferred. Actively practices medicine and provides leadership in the local medical community. Course work in the areas of Health Administration, Health Financing, Insurance, and/or personnel Management is desired. Experience treating or managing care for a culturally diverse population preferred.
WellCare
Tampa, FL
WellCare Health Plans, Inc. provides government-sponsored managed care services. The company operates in three segments: Medicaid Health Plans, Medicare Health Plans, and Medicare Prescription Drug Plans (PDPs). The Medicaid Health Plans segment offers plans for beneficiaries of temporary assistance for needy families, supplemental security income, and aged blind and disabled residents; and other state-based programs, such as children's health insurance programs and long-term services and supports programs for qualifying families who are not eligible for Medicaid.
The Medicare Health Plans segment provides Medicare, a federal program that provides eligible persons aged 65 and over, as well as some disabled persons with a range of hospital, medical, and prescription drug benefits; Medicare Advantage, a Medicare’s managed care alternative to the original Medicare program, which offers individuals standard Medicare benefits directly through Centers for Medicare & Medicaid Services; and coordinated care plans that are administered through health maintenance organizations and require members to seek health care services and select a primary care physician from a network of health care providers.
The Medicare PDPs segment provides Medicare part D PDP plans to Medicare-eligible beneficiaries. Its PDP plans offer national in-network prescription drug coverage, including a preferred pharmacy network. As of December 31, 2018, the company served approximately 5.5 million members in the United States. WellCare Health Plans, Inc. was founded in 1985 and is headquartered in Tampa, Florida.
-
IndustryHealthcare
-
No. of Employees12, 000
-
Website
-
Jobs Posted917
