At HealthPartners, you’ll find a culture where we live our values of excellence, compassion, integrity and most importantly, partnership. By working together, we will improve health and well-being, create exceptional experiences for those we serve and make care and coverage more affordable.
The Chief Health Plan Medical Officer reports directly to the President & CEO, HealthPartners and is accountable for strategic leadership that utilizes and builds on our integrated system capabilities to provide Health Plan medical management and leadership ensuring the delivery of high quality, customer responsive and cost-effective medical services and care to our members and patients while contributing to the growth and profitability of the organization. This position will support and assure effective working connections across the organization including the Care Group, The Institute, and Health Plan functions to realize the full potential of combined organizational capabilities, and provide strategic leadership to build effective partnerships with contracted providers.
In collaboration with the HealthPartners executive leadership team the position is key in the development of long term strategies to assure high performance on the goals of better health and wellbeing for the people served by HealthPartners, affordability of healthcare and supporting internal and external relationships built on trust. The position is responsible for maintaining relationships with regulatory agencies, both state and federal, regarding medical aspects of the Plan. The position is also responsible for maintaining visibility and involvement in the medical community including Institute for Clinical Systems Improvement and Minnesota Community Measurement and organizations nationally, regionally and state-wide to further goals of improving health, enhancing patient experience and effectively managing cost.
Strategy & Leadership:
Contributes as part of the executive leadership team in strategic planning to achieve mission, vision and our business goals. Actively engages in understanding industry trends, marketplace dynamics, and government relations and promotes practice of evidenced-based medicine and population health.
Translate and share learnings from interactions with external audiences to identify opportunities specific to innovation, growth and profitability of the organization and facilitate initiatives internally.
In partnership with SVP, Chief Health Engagement and Analytics Officer, leads efforts to design HealthPartners for Better Health goals and ensure execution as reported to the HealthPartners Board of Directors.
Serves as a key leader to ensure quality in all of our work, co-chair organization-wide Health Council and provides guidance to Chief Quality Officer.
Collaborates with other senior leaders to identify opportunities for improvement and new programs, technologies and strategies that improve health plan operations and care delivery across the care continuum.
Oversees programs and initiatives that improve the quality, efficiency, service and affordability of the care received by HealthPartners plan members by identifying affordability opportunities and strategic alignment.
As Medical Director, has final and ultimate decision making responsibilities regarding medical matters for the Health Plan and ensures medical policies are consistent with NCQA and other regulatory accreditation bodies.
Provides senior medical leadership and direction for HealthPartners Health Plan in areas of utilization/cost management, clinical quality improvement, and medical policy development, and supports Member Appeals and Government Programs as needed.
Provides visible medical leadership and oversight of health plan medical management with state and federal agencies and regulators.
Oversees Complex Coverage Issues and supports member appeals reviews.
Oversees Quality &Utilization (Q&U) strategy development for HealthPartners Health Plan and assists in Pharmacy Q&U strategy development.
Teams with IS&T to develop more effective reporting systems as needed.
Reviews utilization reporting to identify areas for improving utilization management and provider contracting.
Assumes a leadership role with other peer CMO’s to influence management of quality and clinical outcomes.
Team Oversight and Operational Partnerships:
Responsible for managing and leading the health plan medical director team and providing strategic support and leadership for the health services activities of the Associate Medical Directors and their dyad functional directors and managers for utilization management, case management, quality improvement, provider contracting, provider relations and physician services.
Provides strategic support and leadership for quality including oversight of Chief Quality Officer in partnership with the Chief Operating Officer of the Care Group.
In partnership with operational leadership, manages budget and develops and communicates the vision, business plan and annual goals for the Division to ensure alignment with overall HealthPartners' direction.
Attends board meetings and provides staff support to the HealthPartners’ Board of Directors Quality Committee, Member Appeals Committee and other board duties as assigned.
Supports and assures effective working connections across the organization including the Care Group, The Institute, and Health Plan functions to realize the full potential of combined organizational capabilities.
Works collaboratively with leaders across the delivery systems both employed and affiliated to optimize system and health plan performance.
HealthPartners is recognized nationally for providing outstanding care and experience for patients and members. We offer an excellent salary and benefits package. For more information and to apply go to www.healthpartners.com/careers and search for Job ID #53343.
Medical Doctor with an active, unrestricted Minnesota medical license.
Minimum of five (5) years’ experience as a health plan medical director with increasingly responsible assignments.
Minimum of five (5) years of clinical practice experience required
Current board certification.
Excellent interpersonal skills (negotiation, listening and communication skills) characterized by effective interaction with a diverse range of internal and external constituents, stakeholders and audiences.
Demonstrated financial acumen and experience with quantitative financial and clinical results, strategic review, critical thinking and decision making skills
Ability to build effective partnerships and influence other leaders and interface with functions at all levels within the organization
Excellent management skills and the ability to coach and mentor staff.
Proficiency with principals of insurance, managed care, evidence-based practice and medical policy with a philosophy of collaboration and teamwork
Knowledge and experience in principals of population health improvement, quality improvement, and public health issues required.
Ability to be a leader in health policy and community affairs.
Ten (10) years of experience with direct patient care strongly preferred.
Advanced Degree in Health Administration, Business Management or Public Health Preferred.
Experience in developing organizational structure, policies and practice and in the operations of Health Services, Medical Management, Disease Management, Quality, Pharmacy, Behavioral Health, and Appeals and Grievance departments.
Internal Number: 53343
At HealthPartners, you’ll find a culture where we live our values of excellence, compassion, integrity and most importantly, partnership. By working together, we will improve health, create exceptional experiences for those we serve and make care and coverage more affordable. HealthPartners is recognized nationally for providing outstanding care and experience for patients and members. We offer an excellent salary and benefits package. For more information and to apply go to www.healthpartners.com/careers.