CMO - HealthHelp

Company Description

HealthHelp - A WNS Company (www.HealthHelp.com), is the leader in the field of healthcare utilization and care management. We have gained this position by actively working to change out-of-date practices with a collaborative, non-denial based approach. Our methodology helps payors achieve a higher return on investment, gives providers education programs that better inform physicians, and ensures quality and safety for the patients needing treatment. HealthHelp’s innovative approach and strong IT capability in specialty benefits management means that staff will move healthcare forward when provided with evidence-based solutions and second opinions. HealthHelp's staff is comprised of healthcare professionals who make a difference every day. HealthHelp has a desire to fill their company with talented and innovative people who want a career path filled with success and personal growth. Our specialty benefits management services are broad and include, Cardiology, Oncology, Radiology, Radiation Therapy, Sleep Care, and Musculoskeletal Care. HealthHelp is headquartered in Houston, Texas. HealthHelp provides equal opportunities to all employees and applicants without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, marital status, amnesty or status as a covered veteran in accordance with applicable federal, state, and local laws. If you need assistance in completing this application due to a disability, please contact a member of the Talent Acquisition Group to request an accommodation or an alternative application process by emailing talent@healthhelp.com

Job Description

POSITION OVERVIEW

Reporting to the Chief Executive Officer, the Chief Medical Officer (CMO) will have primary responsibility for ensuring clinical quality and program optimization across HealthHelp’s products and be an integral part of driving growth, supporting ongoing client engagement, physician partnerships, product innovation support and thought leadership initiatives. As a core member of the Senior Leadership Team, this role will have high visibility at the Corporate and Client levels while acting as a servant leader to their own teams. The CMO will oversee the organization’s clinical capabilities by ensuring it meets quality and accreditation standards by leveraging extensive experience with prior authorization processes, ecosystem connectivity, and creative problem solving. This role will be responsible for overall clinical integrity by bringing focused structure to quality and accreditation, clinical area outcomes to optimize product performance with rules and guidelines, and to client satisfaction by driving and testing the executed clinical model, ensuring all programs operate on industry standards and regulations. This role will require a clinical background, strong business acumen, data driven decision making, a high level of emotional intelligence, the ability to delegate effectively and treat others with respect.

MAJOR RESPONSIBILITIES

•    Represents and serves as the clinical face of HealthHelp (HH) to health plan clients and providers, prospective clients, associations, Medical Directors, Consult Physicians, nurses, and the general public
•    Confers with board members, organization officials, and/or staff members to discuss issues, coordinate activities, and resolve problems impacting clinical operations
•    Responsible for oversight of all clinical operations entities, including medical director and physician reviewer staff
•    Oversees the HH Quality Management Program and directs its Quality Management Committee
•    Directs, plans, and implements policies, objectives, and activities for clinical programs to ensure their continuing improvement in operational efficiency and effectiveness
•    Oversees the quality of all clinical aspects and assures investors and executive management that all healthcare programs are being implemented and managed properly.
•    Carries out effective, collaborative communication with Program Management and all operations support entities in order to achieve optimal operational coordination of all clinical programs

•    Recommends changes to clinical review protocols and coordinates revisions to clinical criteria, as indicated, ensuring quality and safety for health plan client members and providers
•    Directs staff in the development of educational materials, as needed
•    Conducts educational programs and seminars, as appropriate
•    Responsible for the ongoing development and implementation of inter-rater reliability audit programs
•    Provides oversight for quality improvement projects, as needed

Qualifications

Required 

•    Current, active, unrestricted license to practice medicine in a state or territory of the