The Opportunity: On the heels of a strong 2017 and a solid start to the new year, Fallon Health, a nationally recognized health care services organization, is looking for an experienced, forward-thinking dynamic physician to join the Executive Management team as the new Chief Medical Officer (CMO). Fallon Health is a mission-focused, community-based organization that supports the diverse and changing needs of all those it serves. Established in 1977, Fallon’s early leaders had a vision that brought together all components of the health care system. They were committed to providing high-quality care at an affordable cost. That legacy has been carried forward, creating a culture focused on empathy for its members and the strong drive to develop effective ways to cover their care. The organization draws on its rich, innovative history and deep experience in working closely with members, providers, employers, community leaders, government organizations and others to enhance care and services. Fallon’s commercial, Medicare and Medicaid plans serve people of all ages and income levels. And it is the only health plan in Massachusetts that is both an insurer and a provider of care.
Fallon is poised for continued growth on many fronts—especially with its government programs. In partnership with three well-known provider organizations, Fallon is participating in the historic redesign of the Commonwealth’s Medicaid program (MassHealth). Through these partnerships, known as MassHealth Accountable Care Organization Partnership Plans, the organizations will work together to provide integrated care to MassHealth members, with the goals of improving health outcomes and containing costs. Fallon is also making significant advances in growing and expanding its Senior Care Options program. Significant membership gains were achieved in 2017, growing the organization’s overall market share. Additionally, Fallon is currently the only organization offering a SCO program in Berkshire County. As a provider of care, Fallon has been operating a Program of All-Inclusive Care for the Elderly (PACE) since 1995, which is currently the largest program in New England and 5th largest in the country.
As the organization moves forward with significant momentum, there is considerable opportunity for the next CMO to support a variety of strategic initiatives, as well as generate ideas that support the organization’s commitment to high-quality care and its reputation for building deep, mutually beneficial and innovative relationships with health care delivery systems. In addition, the CMO oversees Fallon’s Care Services organization as well as its PACE program, and reports directly to the Chief Executive Officer.
As a thriving local employer Fallon Health’s latest employee engagement score was 86%, which exceeded the internal target, as well as external benchmarks. Fallon was honored this past year by the readership of the Worcester Telegram & Gazette as a Top Workplace in five out of 10 categories, including best overall company to work for. We welcome you to reach out in strictest confidence to explore this great opportunity further.
SUMMARY: The Chief Medical Officer is a key member of the Executive Management team, engaged in defining the overall business strategy and direction of the organization. The position provides medical oversight, expertise and leadership to ensure the delivery of affordable, high-quality health care services. Responsibilities include the strategic development and implementation of innovative clinical programs, oversight of Fallon’s Care Services organization, which ensures the quality and cost effectiveness of health care services received by members, oversight of Fallon’s PACE program, and oversight of clinical operations for Fallon’s SCO program.
Responsibilities include (But are not limited to):
Ensuring the quality and cost-effectiveness of health care services received by Fallon Health members.
Oversight of all activities and operations within Fallon Health’s Care Services and PACE departments. Ensures ongoing and effective collaboration between Care Services, PACE and all other areas within Fallon Health – particularly finance, operations, sales and compliance.
Maintaining and improving Fallon Health’s NCQA accreditation scores and CMS star ratings.
In collaboration with other departments, developing and implementing effective programs to improve the medical loss ratio for Fallon Health’s products through regular assessment of cost drivers, implementation and management of new programs.
Working to strengthen the relationship and synergy between Fallon Health and its provider partners.
Representing Fallon Health to state and federal regulators, accreditation organizations and other local and national health care professional organizations, associations and partnerships.
Education: Board Certification (highly preferred in Primary Care); Advanced degree in Business/Healthcare and/or completion of the ACPE PIM courses
License: A current license to practice medicine in MA or a willingness to obtain such licensure.
Physician leader with demonstrated record of leading and implementing medical management in a managed care organization.
Medicare and Medicaid experience required.
Expertise encompassing utilization, quality, claims, and disease management.
Experience in NCQA accreditation and CMS star ratings within a health plan.
Strong understanding of present day and future implications of risk contracting.
Additional Salary Information: Highly Competitive
Internal Number: CMO
About Fallon Health
Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit www.fallonhealth.org