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Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware Job Summary: The NovaWell Chief Medical Officer (CMO) is a senior executive physician leader and the chief clinical spokesperson for NovaWell reporting to the President & CEO. At the national level, this position has accountability for all clinical and network strategy, being the clinical face of NovaWell nationally and industry thought leader around integrated care and behavioral health services. The CMO will support business development, client retention, product innovation and network strategy. At the client level, the CMO will be accountable for oversight, development and execution of policies and procedures, utilization management, case management and oversight of medical cost reduction initiatives, population health programs, quality programs, integrated care models, relationship management with clients, review and oversight of external clinical communications.
The CMO has responsibility and final authority for all medical and clinical quality decisions made within NovaWell.
Responsibilities:
Clinical Excellence, Innovation and Thought Leadership: Serves as the chief clinical spokesperson and national champion for the delivery of exceptional clinical program offerings across NovaWell. Key part of the NovaWell business development and client retention team efforts. Acts as NovaWell's primary contact for client health plan clinical leadership relationship management. Leads the embrace of integrated care best practices, cultivating an environment of excellence and continuous advancement. Responsible for the oversight and day to day management of client specific clinical operations. Clinical Strategy, Implementation and Program Outcomes: Leads and meaningfully contributes to the development of integrated clinical strategies to achieve NovaWell's goals of improved access to quality, evidence based, cost effective care, health equity, and member experience. Ensure strategies are effectively communicated internally and externally to all audiences. In concert with clinical and network team leaders, shape clinical quality and performance standards for network providers and enforce clinical quality measures. Product Development and Technological Advancement: Partner with the product development team to conceptualize, develop, and launch groundbreaking healthcare solutions that merge the realms of physical and behavioral health. Advocate for technological integration to create scalable and impactful care models. Strategic Alliances and Advocacy: Build and nurture key partnerships with healthcare providers, health plans, and tech collaborators to forward integrated care initiatives. Act as NovaWell's representative and thought leader in industry gatherings, conferences, and media engagements. Regulatory Compliance and Quality Assurance: Oversee clinical quality programs, ensuring full compliance with all regulatory obligations. Lead NovaWell's efforts in supporting client accreditations from key organizations such as NCQA, URAC and CMS. Leadership and Team Development: Attract, mentor, and retain a premier clinical team including medical directors. Promote a culture of inclusivity, innovation, and accountability. Generate ideas to serve as a basis for ongoing medical cost reduction initiatives, while learning from, and being informed by, other Blues, industry trends and coding changes, CMS regulations, and provider feedback. Develop and monitor goals/outcomes for each client's clinical program; oversee team leadership and provide ongoing feedback, mentoring and coaching. Determines departmental budget and conducts ongoing expense management.
Education/Experience:
Requires a current active unrestricted license to practice medicine; board certification in psychiatry or other behavioral health field preferred. Minimum of 15 years of clinical experience including residency and post graduate clinical practice. A track record of success working with large, complex organizations either within a health plan or provider entity as well as a member of an executive leadership team. Exceptional leadership abilities, capable of inspiring and managing a diverse team of healthcare professionals. A record of healthcare quality accomplishments that demonstrate both passion and leadership in clinical quality, effectiveness and process improvement; in-depth knowledge of principles and metrics of performance improvement. Knowledge of health plan products: commercial, Medicare and Medicaid. Broad clinical knowledge and track-record of clinical excellence along with current knowledge of clinical issues. Strong working knowledge of issues central to achieving success in a competitive health care arena. The ability to attract and recruit top talent, motivate the team, delegate effectively, celebrate diversity within the team, and manage performance; widely viewed as a strong developer of others. Proven results as a visionary and industry thought leader.
Will be held to the Horizon Leadership Attributes:
Relationship Management: Able to build and maintain effective business relationships (internally and externally); demonstrates a commitment to collaboration with appreciation for different perspectives. Seeks ways to draw out differing perspectives to achieve best organizational outcome, and knows how to build buy-in for agreed upon decisions. Conviction: Acts with courage to do the right thing using the framework of compliance and ethics, organizational integrity and public interest; demonstrates strength of character at all times. Leads with confidence and willing to make difficult decisions and champion actions in the best interest of the organization. Implementation Mindset: Sponsors or champions business initiatives using an integrated, risk-based, process-oriented approach and manages the people-side of change; recognizes cross functional collaboration is necessary to achieve required business results and drives this throughout the organization. Drive: Positions the organization for success by establishing challenging yet achievable goals, aligning systems and processes to deliver exceptional business results. Acts with a sense of urgency and resolve in pursing actions to exceed the customers' expectations and deliver organizational success. Forward Thinking: Thinks progressively with the ability to formulate strategies for future success. Creates and/or effectively communicates the vision for the business and able to foster an environment that encourages innovation to generate a competitive advantage.
Salary Range: $261,400 - $363,615
This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:
Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.
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Horizon Blue Cross Blue Shield of New Jersey
tuition reimbursement
Nov 15, 2024