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Job Details

Chief Medical Officer - Growing Health Plan

Company name
Fallon Health

Location
Worcester, MA
15 hit(s)  

Profile

Overview
THE OPPORTUNITY: On the heels of a strong 2017 and a solid start to the new year, Fallon Health, a nationally recognized health care services organization, is looking for an experienced, forward-thinking dynamic physician to join the Executive Management team as the new Chief Medical Officer (CMO). Fallon Health is a mission-focused, community-based organization that supports the diverse and changing needs of all those it serves. Established in 1977, Fallon\u2019s early leaders had a vision that brought together all components of the health care system. They were committed to providing high-quality care at an affordable cost. That legacy has been carried forward, creating a culture focused on empathy for its members and the strong drive to develop effective ways to cover their care. The organization draws on its rich, innovative history and deep experience in working closely with members, providers, employers, community leaders, government organizations and others to enhance care and services. Fallon\u2019s commercial, Medicare and Medicaid plans serve people of all ages and income levels. And it is the only health plan in Massachusetts that is both an insurer and a provider of care.
Fallon is poised for continued growth on many fronts\u2014especially with its government programs. In partnership with three well-known provider organizations, Fallon is participating in the historic redesign of the Commonwealth\u2019s Medicaid program (MassHealth). Through these partnerships, known as MassHealth Accountable Care Organization Partnership Plans, the organizations will work together to provide integrated care to MassHealth members, with the goals of improving health outcomes and containing costs. Fallon is also making significant advances in growing and expanding its Senior Care Options program. Significant membership gains were achieved in 2017, growing the organization\u2019s overall market share. Additionally, Fallon is currently the only  organization offering a SCO program in Berkshire County. As a provider of care, Fallon has been operating a Program of All-Inclusive Care for the Elderly (PACE) since 1995, which is currently the largest program in New England and 5th largest in the country.
As the organization moves forward with significant momentum, there is considerable opportunity for the next CMO to support a variety of strategic initiatives, as well as generate ideas that support the organization\u2019s commitment to high-quality care and its reputation for building deep, mutually beneficial and innovative relationships with health care delivery systems. In addition, the CMO oversees Fallon\u2019s Care Services organization as well as its PACE program, and reports directly to the Chief Executive Officer.
As a thriving local employer Fallon Health\u2019s latest employee engagement score was 86%, which exceeded the internal target, as well as external benchmarks. Fallon was honored this past year by the readership of the Worcester Telegram & Gazette as a Top Workplace in five out of 10 categories, including best overall company to work for. We welcome you to reach out in strictest confidence to explore this great opportunity further.       
SUMMARY: The Chief Medical Officer is a key member of the Executive Management team, engaged in defining the overall business strategy and direction of the organization. The position provides medical oversight, expertise and leadership to ensure the delivery of affordable, high-quality health care services. Responsibilities include the strategic development and implementation of innovative clinical programs, oversight of Fallon\u2019s Care Services organization, which ensures the quality and cost effectiveness of health care services received by members, oversight of Fallon\u2019s PACE program, and oversight of clinical operations for Fallon\u2019s SCO program.
Responsibilities

Ensuring the quality and cost-effectiveness of health care services received by Fallon Health members.
Oversight of all activities and operations within Fallon Health\u2019s Care Services and PACE departments. Ensures ongoing and effective collaboration between Care Services, PACE and all other areas within Fallon Health \u2013 particularly finance, operations, sales and compliance.
Maintaining and improving Fallon Health\u2019s NCQA accreditation scores and CMS star ratings.
In collaboration with other departments, developing and implementing effective programs to improve the medical loss ratio for Fallon Health\u2019s products through regular assessment of cost drivers, implementation and management of new programs.
Working to strengthen the relationship and synergy between Fallon Health and its provider partners.  
Representing Fallon Health to state and federal regulators, accreditation organizations and other local and national health care professional organizations, associations and partnerships.

Qualifications

Education: Board Certification (highly preferred in Primary Care); Advanced degree in Business/Healthcare and/or completion of the ACPE PIM courses
License: A current license to practice medicine in MA or a willingness to obtain such licensure.
Physician leader with demonstrated record of leading and implementing medical management in a managed care organization.
Medicare and Medicaid experience required.
Expertise encompassing utilization, quality, claims, and disease management.
Experience in NCQA accreditation and CMS star ratings within a health plan.
Strong understanding of present day and future implications of risk contracting.

For confidential inquiry contact:Steve.Baraban@fallonhealth.org \u2013 Director, Talent Acquisition \u2013 Fallon Health  
JT18

Company Profile
Our insurance and self-insurance product portfolio includes a variety of group and non-group health plan options (HMO, POS and PPO, as well as Medicaid and Medicare Advantage plans) featuring flexible and innovative benefit designs. In addition, Fallon offers a Program of All-inclusive Care, called Summit ElderCare®, and a Medicare Advantage Special Needs Plan/Senior Care Options program, called NaviCare. Our uniquely developed provider networks offer high-quality, cost-effective, coordinated care and give our members access to physicians and hospitals throughout Massachusetts and southern New Hampshire. We also offer a broad spectrum of health and wellness services and programs to ensure our members, at every stage of life, remain as healthy and productive as possible.

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