San Francisco Health Plan (SFHP) is looking for an innovative, champion of quality to lead the necessary changes that will have a positive impact on our members, providers, and community at large as we continue to grow the culture that can impact the face of community health.

As the Chief Medical Officer (CMO) you are responsible for the quality and efficiency of the health care delivered to San Francisco Health Plan (SFHP) members supported through medical policy formulation, clinical quality outcomes, health services programs development and implementation, quality improvement initiatives and care delivery programs and services.

SFHP embraces a hybrid work environment. This position will be required to be on-site, in-office up to 8 days per month.

Salary Range - $345,000 - $380,000

WHAT YOU WILL DO

• Develop, implement, and evaluate programs within the Health Services department including:
  • Utilization Management
  • Quality Management Improvement Activities including HEDIS improvement strategies
  • Population Health management activities including initiative/mandates intended to enhance care delivery aligned with Triple Aim (improve quality, lower cost and support member and provider satisfaction)
  • Pharmacy and Pharmacy Benefit Management strategies
  • Reports to the Governing Board on progress on the programs.
• Responsible for NCQA accreditation readiness with regard to Quality, Population Health, and Utilization Management standards
• Chair several committee's including Quality Improvement, SFHP-SFHN Joint Operations, and Peer Review Committee
• Directs and monitors non-specialty behavioral health services delivery
• Establishes and maintains strong strategic partnerships with clinical leaders from SFHP’s contracted Medical Groups and will:
  • Provide clinical leadership in the oversight of delegated IPAs and delegated medical groups/clinics’ compliance with contractual responsibilities in delegated activities including utilization, care management and quality management activities
  • Provides clinical leadership to SFHP Facility Site Review (FSR) team and facility site and medical record reviews.
• Drives collaborative partnerships across the Health Services Department, ensuring productive working relationships with other departments
• Ensures that medical decisions at the Plan are rendered by qualified medical personnel, unhindered by fiscal or administrative direction
• Actively participates in the annual DHCS Medical Audit and triennial DMHC Medical Audit
• Develops and fosters collaborative relationships with external stakeholders, including ACAP, LHPC, DHCS, DMHC, SFDPH and LICOHS

WHAT YOU WILL BRING

• M.D. degree from an accredited medical school. Board certified, preferably in a primary care field.
• Licensed to practice medicine without restriction in the State of California or eligible to obtain an unrestricted license in California.
• At least three years of medical management experience in a managed care plan or delegated medical group. It is critical to have solid experience in medical programs administration, including utilization review, quality improvement, complex care management, and provider relations management.
• Expert knowledge of public health and the Medi-Cal/Medicaid population/programs.
• Experience and commitment in managing population health and care collaboration.
• Experience working with providers in the development and implementation of Patient Centered Medical Homes, Accountable Care Organizations, and other innovative programs and initiatives to manage and compensate for care.
• An appreciation and support for medical/clinical analytics, ideally experienced at establishing and utilizing well-designed comparative data, analyzing the data, and taking appropriate actions from such.
• Expert knowledge of the healthcare, economic or other issues affecting Medi-Cal populations, providers and the underserved.
• Solid knowledge of NCQA accreditation, HEDIS and have a contemporary understanding of regulatory and governmental affairs.
• Expert collaboration skills with demonstrated ability to create and foster a collaborative work environment, maintain effective, high performance teams, and organize people and resources to solve problems and identify business opportunities.
• Data driven and strategic ability to lead staff in a manner that maximizes employee performance and business results.
• Superb oral and written communication skills, with the ability to communicate professionally, effectively and persuasively to diverse individuals and groups.
• Demonstrated ability to articulate and embrace organizational values, integrate into management practices, and foster their manifestation among staff.

WHAT WE OFFER

A competitive and robust compensation package, including:

• Health benefits
  • Medical: You’ll have a choice of medical plans, including options from Kaiser and Blue Shield of California. Employee-only coverage in the HMO plans is currently available at no cost and dependent coverage is heavily subsidized by SFHP.
  • Dental: You’ll have a choice of a basic dental plan or an enhanced dental plan which includes orthodontic coverage.
  • Vision: Employee vision care coverage is available through Vision Service Plan (VSP).
• Retirement – Employer-matched CalPERS Pension and 401(a) plans, 457 Plan
• Time off – 23 days of Paid Time Off (PTO) and 13 paid holidays
• Professional development: Opportunities for tuition reimbursement, professional license/membership.
• An opportunity to work in a vibrant atmosphere with the most amazingly talented people who are shaping the future of healthcare!
• The chance to make a difference in the lives of many San Francisco residents!

San Francisco Health Plan is proud to be an equal opportunity employer. We are committed to a work environment that supports and respects all individuals and in which our processes are applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristics.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

San Francisco Health Plan is an E-Verify participating employer.