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The Chief Medical Officer (CMO)-Managed Care Job Details

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Company:  Nurse Resolutions
Job Code:  1688
Categories:  Skilled Nursing / Nursing Home (SNF)
Job Role:  Other
Country:  United States
Region/Province:  Louisiana (LA)
City:  Baton Rouge
Job Description: 

3. The Chief Medical Officer (CMO) shall have a Louisiana license as a
physician, board-certified in psychiatry, and have responsibility for the
effective implementation of all clinical-medical programs, the QM and UM
program in compliance with Federal and State laws and the requirements
set forth in this Contract, including the documents incorporated by
reference. When the CMO is board certified in general psychiatry, the
Medical Director (see below) shall be board certified in child and
adolescent psychiatry, or vice versa. These positions shall have the
responsibility for effective implementation of the QM program and the UM of
services and associated appeals as these functions relate to children and
youth, and adults with SMI and/or addictive disorders. Additionally, the CMO
shall be involved in:
(a) Development, implementation, and interpretation of clinical-medical
policies and procedures.
(b) Physician recruitment and supervision.
(c) Decision making process for approval and denial of provider
credentialing.
(d) Provider profile design and interpretation.
(e) Administration of all utilization management and quality management
activities.
(f) Continuous assessment and improvement of the quality of care provided
to Members.
(g) Development and implementation of the QM/UM plan and serve as the
chairperson of the QM, UM, and Peer Review Committees with oversight
of other medical/clinical committees.
(h) Provider education, in-service training and orientation.
(i) Attendance at regular (at least quarterly) DHH-OBH designated medical
director meetings, including linkage with the CCN-P Medical Directors
for primary care.
iv. Medical Director shall have a Louisiana license as a physician, board-certified
in either general psychiatry or child psychiatry, complementary to
the Chief Medical Officer's board certification in either general or child
psychiatry, and shall have the responsibility for the design of clinical-medical
programs, in compliance with Federal and State laws and the requirements
set forth in this Contract, including all documents incorporated by reference.
136 of 203
A board certified child and adolescent psychiatrist may be substituted with a
board certified psychiatrist in general psychiatry having significant
experience providing services to children and youth.

Abe Ghebrehiwet
Senior National Account Executive
Nurse Resolutions
888.411.2228 ext. 204. Toll Free
407.982.7508. Fax
www.nurseresolutions.com

chief medical officer, (cmo), managed care, insurance, baton rouge, Louisiana

Post Date:  05/24/2012
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