Chief Medical Officer, Brown and Toland Physicians

Job Description

Job Description

About Our Company

At Altais, we’re looking for bold and curious clinicians and innovators who share our passion for enabling better health care experiences and revolutionizing the healthcare system for physicians, advanced care providers, patients, and the clinical community.

At Altais, we’re building breakthrough clinical support tools, technology, and services to let doctors do what they do best : care for people.

We invite you to join our growing passionate team as we change the game for the future of healthcare and enable the experience that people need and deserve.

Altais family of companies include Brown & Toland Physicians, Family Care Specialists and Altais Medical Groups.

About Your Team

Are you looking to work with a high performing, fast growing and dynamic Altais Networks Clinical team? We are 4,000+ physicians, working in over 40 cities throughout California, caring for more than 500,000 patients.

If you are passionate about reshaping healthcare and want to work for a mission driven organization where new ideas and innovation are valued, then we would like to meet you.

About Your Work

The Chief Medical Officer of Northern California plays a vital role in both the development and implementation of Care management and Utilization Management policy and procedures serving Northern California region.

This physician is chosen based upon knowledge of medical practice, experience in Managed Care, Utilization, Management / Quality Management programs and an ability to obtain mutual respect from and interact well with the other physicians.

You Will Focus On :

This role will lead and work to continually enhance the overall efficiency and quality of care for patients served by Altais Health Solutions through effective network management.

This role develops and maintain collaborative functioning relationships with key providers, particularly thought leaders, across the Altais Health Solutions service delivery footprint including providing information for Altais Health Solutions to enable better understanding and skill enhancement in the medical, financial, and utilization practice functions of managed care.

Essential Functions :

• This role is the medical leader responsible for interfacing with health plans regarding benefits, coverage issues, response to appeals, attend HMO hearing on appeals and administrative issues which cannot be settled via normal channels.
• This physician is chosen based upon knowledge of medical practice, experience in Managed Care, Utilization, Quality Management programs and an ability to obtain mutual respect from and interact well with the other physicians.
• Continually enhance the overall efficiency and quality of care for patients served by Altais Health Solutions through effective network management.
• Provide leadership and direction to the UMC (Utilization Management Committee) Primary Care Physicians (PCP) and all Specialist Physicians, Quality Committee, along with participating in the Clinical Advisory Group.

Participate as an active member of the Quality Management Committee bringing the perspective of a medical doctor.

• Work in close partnership with the clinical / utilization management team on our inpatient, case management, SNF, and other utilization management areas to help manage CoHC and bolster existing efforts, including Epic optimization.
• Lead and partner on risk adjustment efforts on HCC recapture with providers. Provide clinical leadership to the work around implementation of new workflows and interventions, along with retrospective coding and chart retrieval work.

Additionally, help with efforts to institute structure on the front end (concurrent / prospective) work with providers and our NP program.

• Chair the credentialing committee and ensure providers in the network have the appropriate experience, education and expertise to provide services to the network patients.
• Responsible for the network provider payment policy and coding guidelines.
• Responsible for being an active member and leader for care management leader meetings by the case managers and / or management.
• Partner and lead closely alongside physician leaders across all healthcare settings to ensure that patient care is managed in a cost containment manner without compromising health outcomes.
• Lead and facilitate clinical rounds with the case managers & management to ensure bed day performance goals are met.
• Take a leadership role in the development and promotion of managed care systems within Altais Health Solutions. This will include development of utilization management and care management policies and procedures from a medical doctor perspective, identifying the type of criteria to be used for authorization review, and implementation of a regular forum in which to educate PCPs and specialists on utilization management systems.
• Serve as an important resource and key contact for identified case management problems and participates in IDCT (Interdisciplinary Care Team) Meetings.
• Be the lead resource for Physician Education on utilization management / care management and input into the Altais Health Solutions utilization management goals and objectives.
• Lead, and coordinate prospective, concurrent, retrospective review including denial and / or approval of all outside medical services referrals, as necessary.
• Oversight for care management quality improvement to medical care review processes.
• Develop and maintain written medical care protocols and assure utilization management / care management standardization.
• Conduct chart reviews for appropriateness in application of clinical guidelines.
• Be the Lead physician liaison for utilization management / care management related issues.
• Lead, prepare and review Decision Validation Criteria as required by utilization management and care management.
• Claims and cost analysis to identify interventions to mitigate trend.
• Lead and oversee concurrent review for inpatient and post-acute team.
• Interface with payors around cost and utilization performance.

The Skills, Experience & Education You Bring

• Doctor of Medicine degree; Current Board certification, preferably in a broad-based specialty such as Internal Medicine, Family Practice, Emergency Medicine, Geriatrics, General Surgery or Pediatrics.
• A minimum of twelve (12) years as a practicing inpatient and outpatient physician in a managed care environment
• 6 years leadership experience.
• Health plan experience in operations.
• Experience in a physician group model.
• Active and in good standing MD licensure in the state of California.
• Strong clinical skills; knowledge of utilization management techniques; strong interpersonal and communication skills.
• Must have a demonstrated ability to secure the trust and confidence of employees at all levels, in a manner that assures an effective, open and productive working relationship.
• Must be effectively and confidently able to provide advice and expertise as a medical professional, and stay abreast of changes, innovations, and trends in the industry
• Ability to translate ethical and legal requirements into practical and sustainable policies, balancing the needs of the business and the interest of patients and member physicians alike.
• Strong leadership skills : being able to lead through change, co-create, design programs, create a trusting inclusive environment, inspire team to meet performance goals, build teams to scale to meet business needs, create a team environment where team members thrive and belong and be a dedicated visionary human leader.
• Drive focused alignment with financial stewardship.
• Be a continuous learner, teacher and mentor.
• Demonstrated ability to provide expert medical advice.
• Successful history as a practicing physician
• Strong ability to build and sustain relationships in the medical community and a corporate environment.
• Excellent communication skills
• Ethical and principled
• Strong problem solver with a can do’ attitude.
• Ability to instill confidence, inspire and motivate others.
• Strong self-awareness and appropriate balance of ego and humility
• Ability to communicate with clarity.
• Maintains strict confidence of Company and client information.

You Share our Mission & Values

• You are passionate about improving the healthcare experience and want to be part of the Altais mission.
• You are bold and curious willing to take risks, try new things and be creative.
• You take pride in your work and are accountable for the quality of everything you do, holding yourself and others to a high standard.
• You are compassionate and are known as someone who demonstrates emotional intelligence, considers others when making decisions and always tries to do the right thing.
• You co-create , knowing that we can be better as a team than individuals. You work well with others, collaborating and valuing diversity of thought and perspective.
• You build trust with your colleagues and customers by demonstrating that you are someone who values honesty and transparency.

Altais values the contribution each Team Member brings to our organization. Final determination of a successful candidate’s starting pay will vary based on several factors, including, but not limited to education and experience within the job or the industry.

The pay scale listed for this position is generally for candidates that meet the specified qualifications and requirements listed on this job description.

Additional pay may be determined for those candidates that exceed these specified qualifications and requirements. We provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs.

The anticipated pay range for this role is listed in our salary posting for transparency but may vary based on factors including the candidate’s qualifications, skills, and experience.

Altais and its subsidiaries and affiliates are committed to protecting the privacy and security of the personal information you provide to us.

Please refer to our CPRA Privacy Notice for California Employees and Applicants’ to learn how we collect and process your personal information when you apply for a role with us.

Physical Requirements : Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office / deskwork Activity level : Sedentary, frequency most of workday.

External hires must pass a background check / drug screen. Qualified applicants with arrest records and / or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance.

All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.