Clinical Risk Manager Jobs in Ashland, VA (NOW HIRING)

The Chief Medical Officer (CMO) of VCU Health System Value-Based Care (VBC) serves as the clinical executive responsible for leading VCU Health's Employee Health Plan, CIN, Direct to Employer, and other Value-Based Care initiatives. This leader will be primarily responsible for designing, leading, and optimizing the clinical care model and care teams supporting Direct-to-Employer customers, including oversight of the Center for Team Care-a comprehensive primary care and population health program for VCU Health employees that serves as a foundation for future direct-to-employer partnerships. This leader will build the Value-Based Care entity's innovative care model, population health, and utilization management programs in such a way as to best serve VCU Health's employees, its CIN at-risk population, and future employer-customers' populations to achieve the Quadruple Aim of Better Care, Better Affordability, Better Patient Experience, and Better Provider Satisfaction. This leader will also serve as an internal and market-facing champion and thought leader for VCU Health's Value-Based Care and Health Care Services Initiatives. The incumbent will creatively design care and population health programs, lead diverse internal care teams, and consult with benefits leaders and executives - both within VCU Health and with external employers - on benefit design, clinical model design, and the best strategies to achieve maximum value for employee benefits and health care spend. The CMO will maintain relationships with clinical and non-clinical executive leaders, current and prospective customers, and across the community to grow the VCU Health brand and expand business opportunities for VCU Health's Value-Based entity and business lines.

Essential JobStatements

Develop and execute the clinical strategy for VCUHS' value-based care model, ensuring the delivery of high-quality, patient-centered care, utilization management, total cost-of-care initiatives, and governance. Sets the clinical vision, develops and implements new population health programs, aligns clinical operations with organizational goals, and develops a strategy for the continued growth of the Direct to Employer and CIN service lines.

Uses data to identify high-risk populations and design targeted interventions. Develop and lead the strategy for risk prediction to optimally identify patients for proactive outreach within Direct-to-Employer and CIN populations.

Leads clinical transformation initiatives for the Value-Based Population to improve patient safety, clinical effectiveness, and regulatory compliance. Coordinates with the Chief Quality and Safety Officer to establish metrics and accountability structures for continuous improvement across all value-based contracts and key performance metrics.

Partners with Senior Leadership, CIN Boards, and CIN community practices to optimize clinical workflows, resource utilization, financial stewardship, and the benefit appeals process.

Collaborates with Finance and Managed Care contracting teams to evaluate and manage clinical risk in shared savings, capitation, and downside risk arrangements, and optimizes current pay-for-performance contract terms. Identify, develop, and lead initiatives to reduce medical and pharmacy cost trends and increase the value of benefits in Direct-to-Employer and CIN populations.

Consult with Direct to Employer customers on benefit design enhancements to improve the value of benefits, the health of employee populations, and medical cost trends. Partner closely with their PBMs and TPAs to develop the highest value benefit plans.

Builds strong relationships with Nursing, Allied Health, and Administrative Leadership to promote integrated patient care delivery.

Champion the adoption of new technologies and evidence-based practices to enhance patient outcomes and system efficiency. Partners with CMIO and IT to optimize EHR workflows, data integration, and clinical decision support tools in support of the IT roadmap for value-based care.

Ensures compliance with accreditation standards (e.g., Joint Commission), federal and state regulations (e.g., HIPAA, CMS), and professional guidelines.

Recruit, develop, and retain a high-performing value-based care clinical team.

Performs other duties as assigned and/or participates in special projects to support the mission of VCUHS and the team. Accepting alternative responsibilities as required.

Patient Population: N/A

Employment Qualifications

Education Required: Medical degree (MD, DO, or equivalent) with board certification in a medical or surgical specialty

Education Preferred: Clinical leadership training. MHA, MPH, MSHA, MBA, or a related graduate degree.

Licensing/ Certification

Licensure Required: Current license to practice medicine in the Commonwealth or Virginia (MD or DO)

Licensure Preferred: N/A

Certification Required: N/A

Certification Preferred: N/A

Minimum Qualifications

Years and Type of Experience Required: 10 years of progressive leadership experience in an academic health system or large integrated healthcare organization

Years and Type of Experience Preferred: 12 years of related leadership experience, including executive-level experience in a health plan, academic health system or large integrated healthcare organization

Other Knowledge, Skills, and Abilities Required: Demonstrated leadership success in value-based care, population health, and/or risk-bearing organizations. Demonstrated success in clinical operations, quality improvement, patient safety initiatives, and healthcare economics. Experience partnering with employer customers and/or other healthcare purchasers on benefit design opportunities that facilitate improved value of benefits and optimal cost trends. Strong record of collaboration with health plan, health system and/or academic leaders. Exceptional communication, strategic thinking, and change management skills.

Strong business skills, including executive presentation skills and healthcare financial acumen. Academic and/or large group practice prior experience as a practicing clinician.Working knowledge of population health strategies and demonstrated success designing and leading these programs.Experience in analyzing and improving population health program ROI. Demonstrated success in designing and executing initiatives that reduce medical cost trend in commercial employer, self-funded, and/or fully insured health plan populations. Expertise in fund flow design and execution in large health systems and between risk-bearing and clinical organizations. Prior experience leading teams to improve processes. Familiarity with performance improvement processes and change management concepts. Experience in implementing clinical guidelines and leading change with practicing physicians.

Leadership in ACOs, clinically integrated networks, Medicare Advantage, or capitated commercial models. Experience with data analytics platforms, risk stratification tools, and performance dashboards. Excellent communication skills with the ability to interface with all levels and departments effectively on a formal, informal, written, and verbal basis.

Other Knowledge, Skills, and Abilities Preferred: Senior Executive experience in both a health plan and a health system. Academic medical center experience.Strong metrics and analytics experience. Experience building an organization/team from the start-up phase. Experience selling health benefits or being an accountable executive with a direct relationship with specific employer health benefit customers. Experience managing value-based initiatives, including population health programs in governmental payer business lines (i.e., Medicare and Medicaid)

Salary range: $369,000 - $539,000

Actual salary offers will be based on several key factors, including relevant work experience, credentials, and qualifications.

EEO Employer/Disabled/Protected Veteran