Job Description

Job Description

Job Description

Summary

Health Care LA, IPA is seeking a Chief Medical Officer (CMO). Reporting directly to the CEO, the CMO will serve as a pivotal leader overseeing all medical aspects of the IPA, including oversight of HCLA’s Management Services Organization (MSO), to help the IPA meet all the regulatory and compliance requirements. The CMO will spearhead initiatives to enhance the performance and quality of care provided by our network of providers, collaborating closely with HCLA’s Health Centers’ CMOs and specialists. The CMO will be instrumental in establishing and fostering relationships with external stakeholders, advocacy groups, and health plan partners. As the physician champion of the IPA, the CMO will play a pivotal role in driving innovation, quality improvement, and strategic growth initiatives. This position offers a unique opportunity to lead transformative change in healthcare delivery within a dynamic and forward-thinking organization.

HCLA IPA History

Health Care LA, IPA is a non-profit 501(C)3 corporation of Federally Qualified Health Centers (FQHCs) and Community Health Centers (CHCs), serving more than 725,000 patients in Los Angeles County. and a trusted resource serving the underserved patient community in Los Angeles County since 1991. HCLA contracts under a full professional risk model for Medi-Cal, Commercial, Covered California, Medicare Advantage and Medi-Medi programs. Ninety-five percent of HCLA IPA’s enrollment is in Medi-Cal Managed Care programs. HCLA IPA is governed by a 15-member board of FQHC and community health center leaders.

Roles and Responsibilities

· Provide strategic leadership and oversight for all medical aspects of the IPA, including MSO’s delegated responsibilities, including utilization management decisions and policies

· Serve as the primary clinical liaison between the IPA and the MSO, external stakeholders, health plan partners, fostering collaborative clinical relationships and strategic partnerships

· Oversee compliance with regulatory requirements, accreditation standards, and quality improvement initiatives, ensuring adherence to industry best practices and established guidelines

· Foster a culture of clinical excellence, professional development, and continuous learning among IPA’s providers to enhance the quality, efficiency, and effectiveness of care delivery across the network

· Represent the IPA in professional forums, conferences, and industry events, advocating for the organization's interests and promoting its reputation as a leader in healthcare delivery innovation and excellence

· Participate in IPA’s Utilization Management Committee and Credentialing Committee meetings

· Chair the IPA’s CMO Committee Meetings

· Evaluate and assist new emerging technologies to be implemented within the IPA

· Assist with the development, implementation and regular review of safety initiatives, practice protocols for emerging chronic conditions, patient care policies, and organizational policies based on evidenced based medicine, best practices, and industry standards.

· Interface with Clinic CMO’s and medical directors to develop and maintain standards of professional expectations and performance for medical and clinical staff

· Assist and support investigations that involve compliance, grievances, and potential quality incidence cases. (Chart reviews, audit related findings)

· Review and help to develop statistical data related to patient care and patient outcomes, to continually improve medical practices

· Provide strategic guidance with IPA growth and retainment of population in all major spaces (Medi-Cal, commercial, Medicare), as well as special vulnerable populations of focus

· Provide as-needed consultation support to case management for complex patient cases.

· Assist and advise with identifying, intervention, and resolution of cases of fraud, waste, and abuse.

Specific Projects for Consideration:

· Implementation/Advocacy of Population Health strategies (risk stratification, empanelment, etc.)

· CPT Coding training

· Standing orders, clinical practice guidelines

· Over/Under-utilization analyses of specialist network providers

Qualifications:

· A board-certified MD or DO with a valid, unrestricted California State medical license.

· Knowledge of Medi-Cal, managed care and value-based reimbursement models preferred.

· Minimum of five years’ experience in healthcare management required, preferably in an FQHC setting.

· Adequate knowledge of healthcare agency regulations and standards.

· Demonstrated leadership and team management skills.

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