The Company is a value-based care company focused on improving quality outcomes for residents of senior living, assisted-living, memory care, long term care and skilled nursing facilities. Through its participation in Medicare shared savings programs, the company aligns quality outcomes with economic incentives for providers.
The Chief Clinical Officer (CCO) serves as the senior clinical leader for the organization’s Medicare Advantage Institutional Special Needs Plan (I-SNP) and Institutional Equivalent Special Needs Plan (IE-SNP). The CCO is responsible for setting and executing the clinical vision, ensuring high-quality, person-centered care, driving risk adjustment accuracy, and managing affordability. This role provides strategic direction and oversight of all clinical programs, quality initiatives, and care delivery models, with a strong focus on improving health outcomes, ensuring compliance, and achieving sustainable financial performance.
Key Responsibilities:
Strategic Leadership
- Develop and implement the clinical strategy for the I-SNP, aligning with organizational goals and financial sustainability.
- Serve as the clinical subject matter expert to the CEO, Board of Directors, and executive leadership team.
- Drive innovation in care delivery models, risk adjustment optimization, and affordability initiatives tailored to the needs of institutionalized members.
Clinical Operations & Care Delivery
- Oversee care management, utilization management, and interdisciplinary care team programs to improve health outcomes and control costs.
- Ensure timely and accurate completion of HRAs and ongoing documentation to support comprehensive risk adjustment.
- Collaborate with network providers and facility partners to optimize care quality and reduce unnecessary utilization, including avoidable hospitalizations and emergency visits.
- Monitor provider performance, clinical outcomes, and total cost of care, implementing corrective actions and improvement initiatives.
Risk Adjustment & Affordability
- Lead clinical risk adjustment strategy, ensuring complete and accurate coding and documentation of members’ conditions.
- Partner with finance to align clinical programs with revenue optimization and compliance requirements.
- Develop and oversee affordability strategies, including medical cost management, value-based care initiatives, and collaborate with pharmacy on drug utilization oversight.
- Ensure care models balance high-quality outcomes with sustainable financial performance for the plan.
Quality & Compliance
- Drive quality improvement initiatives to achieve CMS Star Ratings, HEDIS, CAHPS, and other key benchmarks.
- Ensure compliance with all CMS regulations, NCQA standards, and state requirements governing SNPs.
- Co-Chair the Quality Improvement Committee and other clinical governance bodies.
- Oversee population health programs focused on identifying and managing high-risk, high-cost members.
Member & Provider Engagement
- Champion member experience by ensuring care is goal-directed, culturally competent, and person-centered.
- Build strong partnerships with providers and facilities, offering education and support on risk adjustment, affordability, and quality measures.
- Engage providers in value-based arrangements to align incentives with quality and cost outcomes.
Leadership & Team Development
- Lead, mentor, and develop clinical staff, including nurse practitioners, care managers, and medical directors.
- Promote a culture of accountability, compliance, and continuous improvement.
- Ensure clinical teams understand and contribute to risk adjustment and affordability strategies.
Qualifications:
- MD, DO, NP, or PA with active, unrestricted license; board certification preferred.
- Minimum 10 years of clinical leadership experience, with at least 5 in managed care, Medicare Advantage, or long-term care.
- Demonstrated expertise in I-SNP, Special Needs Plans, or institutional care models strongly preferred.
- Strong knowledge of CMS Medicare Advantage regulations, risk adjustment (HCC coding, RAF scores), affordability strategies, and quality programs.
- Proven ability to manage medical costs while improving member outcomes and satisfaction.
- Data-driven leader with experience using analytics to drive clinical and financial performance.
- Exceptional leadership, communication, and relationship-building skills.
— Sarah J.
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Marketing Manager
★★★★★
Verified
