Chief Clinical Officer - Regional Vice President, Clinical Operations
Cincinnati, Ohio Area
Clinical oversight and responsibility for more than 70 clinicians and support personnel in three sites, with accountability for over 3 million covered lives in five states, and over 2,500 practitioner- and facility-providers. QI / Compliance knowledge of state and federal laws and accreditation regulations related to treatment services, insurance, managed care, CMS, Medicaid, EMTALA, ERISA, HIPAA, HEDIS, URAC, NCQA and JCAHO. Budgetary accountability for Clinical operations and share general budgetary planning responsibility with regional senior management for service region. Implement and develop ongoing Clinically-related Quality Assurance and improvement activities. Direct and develop clinical metric analyses and statistical model building of health information variables related to utilization management, predictive modeling and outlier identification. Member and provider relations and refinement of clinical workflow processes with emphasis on prevention programs and Disease Management models.