Chief Medical Officer Resume Examples

Chief Medical Officer

[company name] was an 800,000 member managed care organization with offices in CT, NY and NJ

• Overall responsibility for designing medical management programs, including quality improvement, disease management, case management and utilization for commercial, Medicare, and Medicaid across 3 states.
• Reduced commercial inpatient utilization by 9% in 2006 relative to 2004
• Achieved NCQA accreditation with designation of "Excellent" in all three states during first attempt at accreditation.

Chief Medical Officer

Oversee all clinical operations for a newly formed Federally Qualified Health Center (FQHC) with 8 locations in Suffolk County. Initially responsible for hiring of all medical staff and providers, and continually directing and supervising all organizational health care policies and procedures for a staff of 110 employees.

• Faced with 3 unprofitable health centers, my expertise played a key role in facilitating the combination of these centers into one newly formed FQHC, which streamlined health care access for medically underserved patients, as well as, increased profitability for the services provided.
• Challenged with fragmented patient care of preventative medical measures at less than 50%, spearheaded a unified Quality Assurance Program, enhancing the patient outcomes and exceeding the performance goals of 80%, in less than one year.
• Dealing with an inconsistent volume of patient loads across multiple locations which limited access to care and reduced revenue, created a Load Balancing Program, which has resulting in an increase in revenue, minimizing financial loss, and an increased job satisfaction among staff.

Director, Office of The Chief Medical Officer

Deliver complete support to the Chief Medical Officer in developing and implementing cross-institutional initiatives of organizational importance, establishing goals and objectives, directing resources and planning efforts, and overseeing progress for the components under Chief Medical Officer purview.

• Directed various special, confidential, or time-sensitive initiatives at the request of the Chief Medical Officer.
• Functioned across organizational units, institutional structures, and governance bodies, to communicate and coordinate strategic priorities of the Chief Medical Officer.
• Cultivated strong partnerships with leadership, faculty, and staff across UW Medicine clinical sites of practice and UW School of Medicine academic units.
• Directed internal operations and staff of the Office of the Associate Chief Medical Officer (6-10 employees).
• Conducted bi-monthly meetings of clinician leadership in care transformation, as well as held quarterly meetings of Medical Directors.
• Administered $12-15M annually in budgets.

Chief Medical Officer

Responsible for overall population health management including utilization management, quality, NCQA accreditation, and clinical compliance. Fifteen direct reports and annual budget of $1.2 million.

• Directed the development of the health plan utilization dashboard to link utilization/claims data to financial projections for a $171,000 in claim expenditures.
• Case management and care coordination program implementation.
• Directed the Utilization Management Private Review Agent License Application completion to meet MIA standards for UM.
• UM process improvements resulted in three-month average rate changes within the first 3 months of employment.
• 24-hour urgent request improved from 85% to 93%.
• 48-hour standard request improved from 81% to 90%.
• Retro/Appeals improved from 95% to 100%.
• Rate increased 1% up to 3%.
• Even with an increase in AD's the appeal rate decreased from 29% to 3.7%
• The overturned rate decreased from 14% to 1.7%.

Vice President of Medical Affairs / Chief Medical Officer

• Developed Strategic Plan for corporate offerings in federal risk programs, point-of-service-plans, and workers compensation.
• Responsible for managing the Medical Department, adjudicating issues of medical necessity, reviewing the status of experimental and investigational treatments, and making medical policy interpretations.
• Implemented a streamlined lab network that resulted in savings of $23 million in the first year.
• Implemented a pharmacy benefits management program that resulted in a 10 % reduction in pharmacy costs in the first year.
• Developed program of disability evaluation and disability claims management
• Developed, implemented and managed the Quality Management Department, and Utilization Management including policies and procedures, and standards of performance for network physicians
• Developed NCQA compatible medical committee structure, by-laws, policy and procedures for each, and chaired each committee.

Associate Chief Medical Officer, Associate Vice President Medical Affairs

Active member of the senior leadership team, with direct accountability for all regulatory and Conditions of Participation (COP) governing the hospital. Responsible for the credentialing of over 650 physicians and allied health professionals and all related activities governing ongoing citizenship and operations.

• Led the organization through many successful regulatory accreditation and certification surveys including but not limited to the Joint Commission, DNV/ISO, Accreditation Council for Continuing Medical Education (ACCME) and the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR).
• Responsible for maintaining accreditation and quality standards for the hospital and all Continuing Medical Education within the Health System, and for the operational oversight of key initiatives related to new program development, quality outcomes, and affiliations with tertiary, community and state partners.
• Collaborated with Massachusetts General Hospital in bringing Tele-Stroke technology and training to the Emergency Department, providing expert second opinion quickly from one of the country's leading stroke care providers.
• Chaired Stroke Program, achieving Gold Plus Excellence for 4 years in a row, Primary Stroke Certification from DNV, and the Target Stroke Award from the American Heart Association and the American Stroke Association, and in 2014 the only hospital in the state with this designation as reported by "US News and World Reports".
• Championed the development and successful implementation of Care Team Rounds system wide to improve efficiency outcomes and communication between patients, families and the care team.
• Initiated the creation of the Patient and Family Advisory Council, earning the NH Hospital Association's "Noah Lord Award for Patient and Family Engagement"
• Oversight of Medical Staff Services including the credentialing and privileging of over 650 providers
• Oversight of all CME accreditation and activities throughout the organization and implemented Schwartz Rounds (compassionate care giver rounds)

Chief Medical Officer and Acting Director

Served as acting director.

• Participated in the planning and organization of medical care activities.
• Organized, coordinated and monitored the academic and professional activities of four trainees.
• Provided continuing medical care.
• Participated in the design of Protocols of medical care.
• Participated in budget design and planning.
• Capacitated and participated in the training of trainees.
• Represented the Hospital in various regional health events.
• Developed curricula and facilitated continuing training sessions for trainees and nurses.
• Provided comprehensive general medical care and emergency care.
• Participated in rapid need assessment for internal immigrant and dislocated people after the January 12th earthquake.

Administrative Assistant to Chief Medical Officer

• Calendar Management / MS Outlook [Temporary Assignment]
• Generated correspondence
• Coordinated meetings via email and telephone
• Prepared Medical Board Meeting Material
• Processed Reimbursements

Executive Secretary to The Chief Medical Officer & Chief Nursing Executive

• Manage daily calendar and administrative duties
• Establish and continually operate state of the art filing system for employee records
• Arrange air and ground travel, including domestic and international flights with visa requirements
• Develop, create, and operate websites for hospital conferences and grant requirements
• Chair large-scale nursing staff events and conferences, including regional and entity-wide events
• Compose presentation material for Board and Executive Director Meetings
• Schedule interviews for Director level candidates with 20+ interviewers per candidate

Executive Assistant to The Chief Medical Officer

• Instituted systems and procedures for the Compensation and Benefits group to eliminate collection issues that resulted from outsourcing our Accounts Payable organization. Implementation of the program reduced escalations by 90%
• Created, tracked and monitored purchase orders and budget line items to ensure expeditious approval and budget compliance for our organization
• Coordinated the logistics for the employee biometric screening program at our San Jose headquarters and throughout the United States. Worked with our benefit vendors to ensure their needs were met, they had access to the venue and all their materials were delivered.
• Managed, tracked and approved executives eligibility for Executive Physical Program for the company. Using the data; prepared and analyzed reports to determine the percentage of executives who were benefiting from the program
• Collaborated with our finance team and an outsourced vendor who was chosen to run our newly constructed health center to get reimbursement for prepaid expenses that were incurred before a vendor was chosen
• Scheduling all travel, speaking engagements and board meetings for outside organizations. Organized all aspects of meetings, including location, catering and accommodations for attendees