Your Future is our Future

At Lumeris, we believe that our greatest achievements are made possible by the talent and commitment of our team members. That's why we are actively seeking talented and collaborative individuals who are passionate about making a difference in the healthcare industry. Join us today as we strive to create a system of care that every doctor wants for their own family and become part of a community that values its people and empowers you to make an impact.

We're excited to consider every qualified candidate authorized to work in the United States, although we are unable to sponsor visas for this role at this time.

Position:

Position Summary:

Job Description:

Primary Responsibilities

• Oversees, coaches, mentors, motivates, supports, and develops a cross-functional team of seasoned people leaders with a broad scope.  
• Responsible for overseeing and coordinating all clinical aspects of the health plan, including medical and pharmacy management, utilization review, and initiatives to ensure care and services provided align with evidence-based guidelines and best practices.
• Ultimately responsible for medical cost management.
• Plans and facilitates medical director meetings to ensure effective communication and collaboration.
• Fosters strong relationships with Essence physicians and partners with medical groups on provider performance management.
• Participates in the alignment of physician incentives, quality measures, and value-based contracts.
• Maintains strong relationships with ARO Value Based Care Enablement CMOs and clinical teams at partnering organizations.
• Directs and monitors medical management activities and quality management programs as needed to maintain compliance with CMS, NCQA and other accrediting bodies.
• Collaborates with the Corporate Chief Medical Officer (CCMO) on clinical strategy, design and approach, facilitating communications, and managing risk on engagements.
• Acts as an internal consultant on clinical program development and special projects for Lumeris customers.
• Provides support to the Accountable Delivery Systems Institute as needed on matters relating to accountable care, physician engagement/alignment, payer and clinical transformation, and the use of top technology in support of the new models of care.
• Contributes to the Clinical thought leadership of the organization through presentations, case studies and scientific articles.

Qualifications

• MD. or D.O. degree, plus Board Certification
• Current, unrestricted medical license
• 15+ years of relevant experience or the knowledge, skills, and abilities to succeed in the role
• 7+ years of people, program, or project leadership experience or the knowledge, skills, and abilities to succeed in the role
• Demonstrated experience in a successful clinical practice
• Substantial Medicare Advantage experience 
• Proven health system, health plan or capitated provider experience with exposure to managing total cost of care, quality, and documentation and coding
• Deep understanding of population health & managed care
• Strong background in administrative clinical leadership
• Solid understanding and experience with population health management strategies  
• Knowledge of healthcare financing and the relation to various managed care products (HMO, PPO, Indemnity, and Medicare Advantage)
• Knowledge of continuous quality improvement theory and practice
• Excellent communication and problem-solving skills
• Demonstrated track record of developing productive working relationships internally and externally at all levels
• Expert ability to positively impact results

Working Conditions

• While performing the duties of this job, the employee works in normal office working conditions.

Disclaimer

• The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.

Pay Transparency:

Factors that may be used to determine your actual pay rate include your specific skills, experience, qualifications, location, and comparison to other employees already in this role. In addition to the base salary, certain roles may qualify for a performance-based incentive and/or equity, with eligibility depending on the position. These rewards are based on a combination of company performance and individual achievements.

The hiring range for this position is:

Benefits of working at Lumeris

• Medical, Vision and Dental Plans

• Tax-Advantage Savings Accounts (FSA & HSA)

• Life Insurance and Disability Insurance

• Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days)

• Employee Assistance Program

• 401k with company match

• Employee Resource Groups

• Employee Discount Program

• Learning and Development Opportunities

• And much more...

Be part of a team that is changing healthcare!

Member Facing Position:

Drug Screen Requirement:

MVR Required:

Credit Check Required:

Location:

Time Type:

Lumeris and its partners are committed to protecting our high-risk members & prospects when conducting business in-person. All personnel who interact with at-risk members or prospects are required to have completed, at a minimum, the initial series of an approved COVID-19 vaccine. If this role has been identified as member-facing, proof of vaccination will be required as a condition of employment.

Disclaimer:

• The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individual with disabilities to perform the essential job duties and responsibilities.

Lumeris is an EEO/AA employer M/F/V/D.