Chief strategy officer [h1.location_city]

Job Title

Provides executive level strategy and leadership to the health plan in the development and execution of care management and utilization management programs. Develops clinical practice guidelines and oversees appropriateness and medical necessity of services provided to plan members - targeting improvements in efficiency and satisfaction for members and providers. Partners with executive leadership team to provide cohesive direction towards company goals. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties

• Provides executive strategy, vision and direction to the health plan for the medical affairs function. Provides strategic support for design / implementation / execution for programs related to quality improvement, utilization management, care management, predictive modeling and disease management. Responsible for performance and financial results of medical affairs function, and keeps executive leadership apprised.
• Leads the health plan's analysis of medical care cost and utilization data. Leads and manages the development of techniques to effectively correct identified and anticipated utilization problems while assuring that members receive the care they need.
• Provides leadership, direction and oversight functions to the health plan's medical management staff to achieve best in class performance as defined by identified metrics.
• Demonstrates a positive leadership role in key health plan medical management initiatives aimed at optimizing utilization of medical resources.
• Oversees and directs the rendering of medical management decisions at all levels of the health plan that maximize benefits for members while pursuing and supporting corporate objectives.

Required Qualifications

Preferred Qualifications

Pay Range : $246,251.34 - $480,190.11 / ANNUAL