Chief Medical Officer - Value Based Care

About the role

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.

Responsibilities

• 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.
• Set the clinical vision, develop and implement new population health programs, align clinical operations with organizational goals, and develop a strategy for the continued growth of the Direct to Employer and CIN service lines.
• Use 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.
• Lead clinical transformation initiatives for the Value-Based Population to improve patient safety, clinical effectiveness, and regulatory compliance.
• Coordinate 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.
• Partner with Senior Leadership, CIN Boards, and CIN community practices to optimize clinical workflows, resource utilization, financial stewardship, and the benefit appeals process.
• Collaborate with Finance and Managed Care contracting teams to evaluate and manage clinical risk in shared savings, capitation, and downside risk arrangements, and optimize 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.
• Build 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.
• Partner 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.
• Ensure compliance with accreditation standards, federal and state regulations, and professional guidelines.
• Recruit, develop, and retain a high-performing value-based care clinical team.

Qualifications

• Medical degree (MD, DO, or equivalent) with board certification in a medical or surgical specialty
• Current license to practice medicine in the Commonwealth of Virginia (MD or DO)
• 10 years of progressive leadership experience in an academic health system or large integrated healthcare organization
• 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
• 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

Skills

• 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
• 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