Clinical Program Officer, Diagnostic Solutions

Summary:

The Clinical Program Officer, Diagnostic Solutions has primary clinical oversight of EviCore by Evernorth’s radiology, cardiovascular, sleep, and gastroenterology management programs and services.

Responsibilities include:

• Lead overall clinical program performance for all radiology, cardiovascular, sleep and gastroenterology and other assigned programs based on business need, including policy, clinical review decision, appeals, audits, and other clinical functions
• Supervise performance of clinical reviewers in radiology, cardiovascular, sleep, and gastroenterology programs
• Collaborate as program clinical contact for client medical leadership concerning clinical policy, quality, program development, clinical criteria, and provider issues for radiology, cardiovascular, sleep, and gastroenterology programs.
• Diagnostic Solutions clinical contact for client medical leadership concerning clinical policy, quality, program development, clinical criteria, and provider issues for radiology, cardiovascular, sleep, and gastroenterology programs
• Evaluate utilization trends, referral patterns, fraudulent medical practices, quality standards, regulatory changes, program performance, and client feedback for radiology, cardiovascular, sleep, and gastroenterology services, and recommend solutions for improvement where needed.
• Oversee clinical policy development for all radiology, cardiovascular, sleep, and gastroenterology programs, and facilitate collaboration with other clinical programs to ensure optimal process and content harmonization
• Collaborate with Talent Acquisition and Clinical Operations as subject matter expert (SME) for radiology, cardiovascular, sleep, and gastroenterology program clinical hires
• Participate as senior leadership in strategy, planning, and budgeting for radiology, cardiovascular, sleep, and gastroenterology programs as well as in execution of annual program goals, accountable to the General Manager of Diagnostic Solutions
• Collaborate with Talent Acquisition and Clinical Operations as subject matter expert (SME) for radiology, cardiovascular, sleep, and gastroenterology program clinical hires
• Attend key professional meetings and support marketing initiatives as a representative thought leader of EviCore for Diagnostic Solutions topics.
• Establish informal and formal mechanisms to promote and maintain credibility, competence, and positive corporate image by exhibiting effective communication to clients, providers, committees, and employees.
• Drive a culture of open communication and transparency across all stakeholders.
• Remain flexible in the face of ongoing change as the organization evolves.
• Ensure EviCore radiology, cardiovascular, sleep, and gastroenterology program compliance with all NCQA, URAC, and other regulatory requirements and oversee clinical program support to audit teams.
• Participate in all required educational and quality improvement activities and maintain passing scores in all assessments.
• Supports other duties based on business need and priority.

Minimum education, licensure, and professional certification required: 

• M.D. or D.O. degree from an accredited institution.
• Minimum of five (5) years of clinical practice experience after completion of all graduate medical education training, including residency and fellowship (when applicable)
• Active board certification in medical or surgical specialty or subspecialty
• Active unrestricted license to practice medicine in a state or territory of the United States as a Doctor of Medicine or Doctor of Osteopathic Medicine.
• Knowledge of applicable state and federal laws, CMS, URAC and NCQA standards, and utilization management

Minimum experience required (number of years necessary to perform role):

• Three (3) or more years of managed care experience
• Supervisory and/or management experience; 5+ years of people leadership preferred.
• Familiarity with automated processes and computer applications/systems is required.

Competencies:

• Collaborates & Communicates Effectively
• Drives Engagement & Develops Talent
• Builds Networks - Cultivates relationships across boundaries to enhance collaboration and resource sharing.
• Drives Results - Inspires teams to achieve ambitious goals, even in challenging circumstances, by removing barriers and celebrating progress. Ability to connect daily actions to long-term organizational objectives, ensuring that results contribute to the broader mission.
• Strategic Mindset - Anticipates future trends and positions the organization for long-term success. Ability to develop and communicate a compelling vision, translate strategy into act