Physician - Chief Medical Officer Ochsner Health Plan - New Orleans, LA

Position Highlights:

This position reports to the Chief Executive Officer and provides leadership for the development and evaluation of:

• Clinical care systems that improve the health of our members through a population health approach.
• Collaborates with all aspects of the OHP s medical policy, clinical utilization management programs and clinical benefit determinations.
• Position works closely with the OHP leadership team to ensure effective development, deployment and measurement of network activities, medical cost initiatives and quality improvement programs in support of the health of our members.
• This position collaborates on strategic clinical relationships including committee work with providers and on the development of the clinical content for care management programs.
• The OHP Medical Officer broadly supports network provider engagement and provider detailing and integration with quality programs, as well as accreditation development.
• Through metric reporting and case sampling, oversees and reports vendor management compliance for appropriate use of medical necessity requirements, clinical coverage policies, timely and appropriate decision making for pre-service authorizations and adherence with notification requirements, appeals, grievances and claims activity.

Experience/Knowledge required:

• Local and National Medicare Coverage Determinations, Milliman Utilization criteria
• Medical policy/procedure development
• HEDIS quality measurements for health plan STAR Ratings
• Leadership ability to meet with providers to discuss utilization and medical management at Joint Operating Committees
• Working knowledge of CAHPS/HOS Surveys
• Part D experience in particular, formulary management and design
• Extensive working knowledge and understanding of the CMS Organization Determination, Appeals and Grievances (ODAG), Medicare claims and coding guidelines, rules, and regulations that Medicare Advantage plans must adhere to.

Compensation and Benefits:

• Salary is commensurate with experience and training
• Paid vacation, holidays and CME
• Full benefits including medical, dental and vision insurance
• Additional benefit options focused on physical, financial, social and mental health
• Retirement options (401k, 403b, and 457b)
• Relocation assistance
• Malpractice and tail insurance

Why Choose Ochsner Health:

• More than 36,000 employees and over 4,600 employed and affiliated physicians in over 90 medical specialties and subspecialties.
• Operates 47 hospitals and more than 370 health and urgent care centers across Louisiana, Mississippi, Alabama and the Gulf South.
• Flexible schedules to ensure a healthy work-life balance.
• Integrated health care delivery model with multi-specialty collaboration, large internal referral network and innovative resources dedicated to improving patient care and your ease of practice.
• Physician-led organization that ensures our providers are given the tools and support needed to care for patients.
• Professional development opportunities in teaching, research, physician leadership and community service.
• EPIC medical record platform utilized throughout the health system to enhance flexibility in patient management.
• Our dedication to diversity, equity and inclusion is demonstrated by hiring a workforce that celebrates individual uniqueness among people and cultures. We focus our efforts in key areas that correlate back to our core values of Patient First, Compassion, Integrity, Inclusivity, Excellence and Teamwork.