The Chief Medical Officer is a key member of the senior executive team responsible for ensuring access to high quality healthcare for the members of 1199SEIU workers in New York’s healthcare industry. He/she will work to address a wide variety of issues related to the benefit plan design and management of the overall business strategy and direction of the Fund.

Reporting to the Executive Director, this position leads the overall vision for improving health benefits and provides clinical direction to the leadership staff engaged in ensuring access to high quality, cost-effective health benefits for multiemployer benefit plan members, including but not limited to medical, prescription, vision, dental, behavioral health, and wellness.

RESPONSIBILITIES:

• Provides strategic direction on benefit plan design for each Fund. Plans, organizes, and directs clinical management programs.
• Provides rigorous, consistent, and disciplined oversight and analysis of benefit programs to ensure healthcare services to members are of high quality and cost effective.
• Uses data analysis to identify opportunities for quality improvement and to positively influence benefit plan designs.
• Participates in policy review, performs analysis, and makes recommendations; design and implement action plans to improve plan and network managed care performance.
• Maintains up-to-date knowledge of new information and technologies in healthcare and their application to the health plan; recommends changes in plan design in concurrence with industry changes.
• Identify opportunities to collaborate and develop clinical integration with health delivery systems to achieve affordable outcomes.
• Create and maintain programs that incentivize providers to achieve selected utilization/cost and quality outcomes
• Assists the contracting process of providers, hospitals, ancillary providers, by evaluating the medical aspects of provider contracts in keeping with Funds’ goals of value based benefit design and contracting initiatives.
• Responsible for the development of budgets, staffing plans, assuring the adequate allocation of resources.

QUALIFICATIONS:

• Doctorate Degree in Medicine; advanced degree in business or public health desirable
• Board Certified (primary care or internal medicine preferred); active and current state medical license without encumbrances.
• 10 Years leadership experience in the health care delivery system, e.g. clinical and health care industry required; HMO/Managed Care leadership and management experience
• Strategic and innovative thinker with proven ability to communicate a vision and drive results
• Demonstrated ability to make strategic decisions based on a thorough understanding of plan design, industry issues, trends, and the regulatory landscape.
• Superb analytical skills with ability to analyze health claims data including utilization and costs in a health benefits or health insurance environment and arrive at valid conclusions, recommendations, and plans of action
• Must have the ability to plan, coordinate, and direct the work of subordinate staff engaged in various professional, technical, and clerical functions

We offer a competitive salary, an excellent fully employer-paid comprehensive benefits package, and talented professional colleagues.

For consideration and to apply, please visit us at: http://1199seiubenefits.org/ click on “About 1199SEIU Funds” and “Jobs”. Please mention you saw this ad in NEJM. We are an Equal Opportunity Employer.