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ProgenyHealth is a leading provider of care management solutions for premature and medically complex newborns. We partner with health plans and their neonatal providers to work collaboratively in developing a plan of care specific to the needs of each child - from admission to the intensive care nursery until they are safely transitioned from the hospital, through the first year of life. Our program promotes appropriate utilization, improves access, educates family members, reduces costs, and improves outcomes.Job RoleThe Chief Medical Officer will be joining a company passionate about innovative approaches to improving the health outcomes of high-risk newborns and their families and doing everything it takes to make that happen. The right individual for this role will be someone who lives our core values and is comfortable working in a fast-paced environment.The day to day responsibilities in this role will include overseeing the ProgenyHealth Medical Management program, with responsibility for the outcomes and results of the Health Services Department, which includes Utilization and Case Management functions, in conjunction with the SVP of Clinical Operations. The role will also include oversight of the Medical Director team and managing the Quality Management department.The right person for this role will be comfortable analyzing data to monitor and measure the effectiveness of our clinical management programs. They must be a metrics driven and detail-oriented leader with the ability to successfully achieve the strategic growth objectives of their teams and our broader organization. The CMO frequently supports our sales team in speaking with prospective clients and he/she must be comfortable representing the company externally at customer or industry-related meetings, as needed.He/she must be humble and mission-driven, dedicated to supporting a stellar internal culture as well as working to provide the highest quality of service to the families we serve. Progeny’s CMO will be a determined problem-solver, with the ability to make tough decisions with little guidance, and in the face of ambiguity. He/she should be an honest communicator and collaborator, and should be excited about the prospect of working across all levels of the business to drive results.Responsibilities Include:
Maintains and oversees the Utilization Management (UM), Case Management (CM) and Quality Management (QM) Programs and monitors adherence and compliance by reviewing and analyzing company data and dashboards to measure effectiveness. Must have significant experience monitoring and refining key performance indicators and dashboards of the business.
Optimizes customer satisfaction/loyalty through program results. Prepares, evaluates and presents client annual program results at annual client meetings, as needed.
Will assist with the implementation and successful launch of new clients, new product lines and/or technologies, as needed, to keep our program cutting edge and highly innovative in the marketplace.
Oversight of Progeny’s Medical Director team to ensure fair and consistent medical necessity decision making through the use of approved criteria and guidelines, including providing guidance as needed,
Improves workflow and processes to be more efficient and effective in the delivery of ProgenyHealth services to its clients.
Responsible for our continued successful accreditation by URAC and NCQA, as well as oversight of all State, Federal and Client standards/regulations necessary for Progeny to provide our services to our customers.
Leads the Medical Advisory Board and Medical Management Committee/Quality Improvement Committee and manages relationships with members that include practicing Neonatologists across the US.
Oversight and management of Quality of Care issues.
Qualifications
MD/DO degree and Board-Certified in Pediatrics or Neonatology is required
MBA or MHA degree preferred
Minimum of 3-5 years clinical practice experience after residency
Minimum of 7-10 years in managed care with health plans, including 3-5 years in a Senior leadership role.
Experience in UM/CM/QM management and the maintenance of URAC & NCQA accreditation.
Humble player-coach who can roll up his/her sleeves and collaborate across all levels of an organization.
Mission-driven executive with a desire to improve the health outcomes of high-risk neonates.
Must be located in or willing to relocate to the Philadelphia, PA area.
Must have excellent computer skills and be proficient in Microsoft Office.
Must possess an active, unrestricted license to practice medicine. Must be willing to obtain licensure in additional states based on business needs.
Benefits/CultureOur team is our most important asset. some of the benefits we offer our team are:
401K with company match
Medical and dental benefits
Long Term Disability
Paid Time Off
Business Casual Work environment
Team orientated events throughout the year
