PCHP - Parkland Community Health Plan Remote PRIMARY PURPOSE Oversees medical coordination required for effective utilization and quality management of the health plan network. Supports the clinical activities of PCHP Utilization Management, Quality Management, Clinical Policy, Technology Assessment, Credentialing, Population Health and Fraud, Waste and Abuse Functions to assure comprehensive, high quality health care to plan members in accordance with managed care and PCHP policies. Monitors clinical care needed to produce optimal health outcomes and cost-effective care. MINIMUM SPECIFICATIONS Education - Must have successfully completed an Accreditation Council for Graduate Medical Education (ACGME) or American Medical Association (AMA) approved residency in an appropriate specialty to the PCHP population. - Master's degree in business administration, healthcare administration, or a related discipline preferred. Experience - At least five (5) years of clinical practice experience in a specialty relevant to the care of PCHP members. - Experience in the development of medical policies, procedures and programs is preferred. - Qualifications to perform clinical oversight for the services provided by the health plan to include but not limited to education, training or professional experience in medical or clinical practice preferred. - Past participation in a managed care UM committee preferred. - Peer Review, medical policy/procedure development experience preferred. - Experience in Utilization/Quality Program management preferred. Certification/Registration/Licensure - Must be currently licensed for the practice of medicine in the State of Texas. - Must meet and maintain licensing and registration requirements as required by the State of Texas for Managed Care Medical Directors. - Board certification in the relevant specialty preferred. Skills or Special Abilities - Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms. - Working knowledge of managed care principles and Texas Medicaid Regulations is preferred. - Must understand and demonstrate knowledge of principles of care coordination and collaboration, population health and social determinants of health, clinical evaluation of evidence-based care and value-based purchasing. - Must be familiar with the role of pharmacy and behavioral health in managing health care. - Ability to apply medical knowledge and principles to business challenges in order to achieve significant member, business, and quality outcomes. - Demonstrated ability to coach and influence for results. - Strong interpersonal and conflict resolution skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization. - Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals. - Ability to work in challenging situations involving competing interests, and high level-interdisciplinary groups. - Excellent time management and organizational skills with the ability to manage multiple demands and respond to rapidly changing priorities. - Strong analytical and problem-solving skills. - Knowledge of Texas Medicaid (STAR, STAR Kids/CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual. - Sound business acumen. - Proficient Microsoft Office and computer skills. Responsibilities Operations - Reviews prior authorization, concurrent, and pre-service and post-service appeals request for medical necessity and resolves grievances related to medical quality of care. - Participates in identification and analysis of process improvement of jobs design, work processes, and workflows for the clinical area and implements appropriate changes to improve effectiveness, productivity, and efficiency that support the overall goals of the managed care delivery system and PCHP. - Facilitates conformance to Medicaid, NCQA and other regulatory requirements. - Provides clinical oversight for utilization management, disease management and quality management activities as assigned by the PCHP Chief Medical Officer or Medical Director including participation in development of medical policies and procedures for coverage and authorization and clinical standards and guidelines based on evidence-based medicine. As assigned by the Chief Medical Officer or Medical Director, serves as chairperson or member of managed care committees, and participates on various community and interdisciplinary committees. - Performs peer to peer calls as necessary to support the utilization management process. Strategy - Assists the Chief Medical Officer or Medical Director in oversight, evaluation, and administration of the clinical aspects of PCHP fraud, waste and abuse programs. - Assists the Chief Medical Officer or the Medical Director and the Pharmacy Director of PCHP in overseeing and administering the pharmacy benefit for PCHP members including coordination of care between the Medical and Pharmacy benefits. - Analyzes data to establish health care provider profiles and define acceptability of physician performance and evaluates the effectiveness of UM practices by actively monitoring for over and under-utilization. - Participates in development, implementation, and monitoring of annual goals and objectives for PCHP that support the mission and objectives of Parkland. - Participates in assessment of existing education programs offered to providers and members, developing and evaluating such programs, and provides implementation support for Quality Improvement activities. Quality - Integrate health literacy principles into all communication including Members and Providers. - Support strategies that meet clinical, quality and network improvement goals. - Promote the use of Health Information Technology to support and monitor the effectiveness of health and social interventions and make data-driven recommendations as needed. - For staff in clinical roles, foster collaborative relationships with members and/or providers to promote and support evidence-based practices and care coordination. Regulatory - Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations. As assigned by the Chief Medical Officer or Senior Medical Director, assists in representing PCHP on clinical activities with relevant State and local bodies such as the Texas Department of Insurance, Texas Health and Human Services Commission, and Texas Medical Association. - Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards. - Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary. - Works collaboratively with leadership and/or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary. - Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies. Fiscal Management and Operating Budget - Promote activities to achieve operational efficiency. - Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs. Professional Accountability - Acts with the highest integrity and ethical standards while adhering to Parkland's Mission, Vision, and Values. Adheres to organizational policies, procedures, and guidelines. - Completes assigned training, self-appraisal, and annual health requirements timely. - Adheres to hybrid work schedule requirements. Attends required meetings and town halls. - Recognizes and communicate ethical and legal concerns through the established channels of communication. - Demonstrates accountability and responsibility by independently completing work, including projects and assignments on time, and providing timely responses to requests for information. - Maintains confidentiality at all times. - Performs other work as requested that is reasonably related to the employee's position, qualifications, and competencies. Job Accountabilities - Identifies and analyzes the design of jobs, work processes, workflows, etc. for the area and implements appropriate changes to improve effectiveness, productivity, and efficiency that support the overall goals of the department and Parkland. - Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices. - Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding. - Develops and monitors annual budgets that ensure the department has the necessary funds to carry out the goals and objectives that have been established for the department. - Develops, implements, monitors, and revises annual goals and objectives for the department that support the missions and objectives of Parkland. - Selects, trains, schedules, motivates, supervises, and evaluates employees making recommendations for disciplinary actions up to and including termination, to ensure maximum utilization of individual and group capabilities. - Ensures that assigned employees receive opportunities to further their knowledge.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Under the direction of the CEO, the CMO oversees Jefferson Center’s medical operations, with a focus on supporting all medical services, including outpatient psychiatry, pharmacy, nursing, integrated care, and other acute care related services. The CMO ensures clinical excellence, regulatory compliance, and operational efficiency across medical services, while fostering collaboration with internal teams and external partners. Qualifications - MD or DO degree (or international equivalent). - Unrestricted Colorado medical license and DEA certificate. - Satisfactory completion of ACGME-accredited residency training program in Psychiatry, Internal Medicine, Family Medicine, or similar. - Preferred - ACGME-accredited residency training program in General Psychiatry (adult psychiatrists) and in Child and Adolescent Psychiatry (if a child and adolescent psychiatrist). - ABPN Board-certification is desirable but not required. - Bilingual (Spanish/English) competency preferred. Requirements - Understand and provide leadership to staff regarding community mental health systems of care. - Understand and provide leadership regarding healthcare transformation and integration across primary and specialty medical care, oral healthcare, behavioral healthcare, and other components of community systems of care. - Be knowledgeable and current regarding emergency medicine, inpatient medicine, psychopharmacology, medical/psychiatric interface; evidence-based neuropsychiatric/neurobehavioral diagnosis and treatment preferred. - Be able to provide leadership to/collaboration with multidisciplinary mental health teams in the delivery of comprehensive, integrated, and clinically appropriate interventions. - Be experienced in administration, clinical and administrative supervision, and systems management. - A minimum of 7 years of relevant experience in the aforementioned domains is required. - Demonstrated expertise in crisis services and medical regulatory compliance; substance use and addiction recovery experience preferred. - Strong interpersonal and organizational skills, with ability to lead cross-functional teams. Key Responsibilities - Clinical Oversight & Program Leadership - Provide effective medical leadership, guidance, and supervision for center’s prescribing staff, including Psychiatrists and Advanced Practice Nurses. - Supervise medical directors, director of nursing services, and assigned clinical directors and managers, ensuring coverage, quality, and coordination across programs. - Lead clinical evaluations and consults for admissions, including infectious disease screening and medical appropriateness assessments. - Co-lead Critical Incident Review Committee and Clinical Reviews to ensure quality medical and clinical services are provided. - Review and approve referrals for potential clients on Emergency Commitments, Involuntary Commitments, and Short-term Certifications with Court Ordered Meds. - Support implementation of evidence-based practices, including Medication-Assisted Treatment (MAT), trauma-informed care, Zero-Suicide initiative, outcomes measures including measurement-based care, and harm reduction strategies. - Regulatory & Compliance - Ensure adherence to Behavioral Health Administration rules, Colorado Department of Human Services/Residential Child Care Facility licensure requirements and Volume 7 regulations, including staff adherence to required training, including CPR, First Aid, and Qualified Medication Administration Personnel training. - Collaborate with HR and program directors to embed compliance into hiring and auditing workflows including personnel file documentation and required pre-employment physicals. - Lead efforts to update and align medical and nursing documentation, policies, and naming conventions to match agency-wide requirements. - Operational Strategy & Innovation - Engage actively, using a systems approach, in strategic planning and implementation. - Set operational and/or performance goals with department that are tied to organizational goals. Monitors department performance against performance goals to ensure that progress is being made. - Lead development of workflows that improve access to medical services and streamline admissions, including direct admit protocols and prescreening tools. - Partner with community stakeholders to address barriers to care and enhance referral pathways. - Contribute to Monthly Business Reviews (MBRs), analyzing census, revenue, and staffing metrics to drive performance improvements. - Technology & Systems - Ensure integration of medical workflows into systems like Avatar and key performance indicator dashboards. - Ensure all medical staff are properly trained in the use of the Electronic Health Record (EHR) and are adhering to the documentation requirements as set forth in Rule, Statute and Jefferson Center Policies & Procedures. - Collaboration & Communication - Serve as a liaison between medical services and Executive Leadership Team (ELT), participating in ELT meetings, strategic planning. - Collaborate with Clinical Services, Operations, Administration/Finance, and Business Development to align medical priorities with organizational goals. - Represent medical services in regulatory communications and community engagement efforts. Salary Range - $300,000 to $338,400* - The salary range above is based on 1.0 FTE (full time equivalent) or 40 hours per week. Less than 40 hours/week will be prorated and adjusted to the appropriate FTE. - Salaries at Jefferson Center are calculated based on education level, licensure, years of experience, and internal equity amongst current JCMH staff. Application Deadline - 03/09/2026. Review of applications will begin immediately.

• Directly manage, coach, and mentor a team of MSLs within an assigned region, providing ongoing performance feedback, development planning, and field coaching to enhance scientific acumen, engagement quality, and professional growth • Recruit, onboard, develop, and retain a high-performing team of MSLs, fostering a culture of scientific rigor, accountability, collaboration, and continuous improvement • Ensure consistent execution of MSL core responsibilities, scientific engagement standards, and compliance expectations across the region • Establish clear performance expectations and development plans aligned with medical strategy and organizational priorities • Partner with Medical Affairs leadership and Director, Field Medical Training to support MSL onboarding, training, and ongoing professional development • Conduct regular field rides, virtual touchpoints, and performance reviews to assess effectiveness and alignment with Medical Affairs objectives • Foster an inclusive, collaborative, and high-performance team culture • Translate Medical Affairs strategy into clear, actionable objectives, field medical plans, and execution of priorities aligned with company objectives • Ensure regional MSL activities support disease-state education, scientific exchange, and clinical data dissemination in cardiovascular, renal, and metabolic disease areas • Ensure consistent, accurate, and compliant scientific messaging across all field activities through field observation • Support MSL participation in medical congresses, advisory boards, investigator meetings, speaker training, and other scientific forums • Monitor and optimize regional coverage plans, KOL and regional payer engagement strategies, and field medical priorities • Oversee regional KOL identification, profiling, and engagement strategies across academic and community settings • Maintain in-depth knowledge of relevant therapeutic areas, disease states, and competitive landscape to support high-quality scientific exchange • Ensure high-quality, compliant scientific interactions with HCPs, thought leaders, and regional payers • Serve as an escalation point for complex scientific discussions and high-priority stakeholder engagements when appropriate • Support regional insights generation related to disease management trends, unmet needs, and competitive intelligence • Act as a strategic partner to internal cross-functional teams to align on priorities including Medical Affairs, Clinical Development, Regulatory, Commercial, and Market Access • Ensure timely communication of field medical insights to inform clinical strategy, medical planning, and future launch readiness • Collaborate with clinical teams to support site engagement, investigator-sponsored research opportunities, and trial support activities with Clinical Development as needed • Provide input into regional resource planning, budgeting, and operational priorities • Support medical launch readiness and execution for new indications or assets, as applicable • Ensure all regional field activities are conducted in compliance with company SOPs and applicable regulations (FDA, PhRMA, PDMA, etc.) • Establish and monitor key performance indicators (KPIs) to assess scientific engagement quality, impact, and operational effectiveness • Oversee accurate and timely documentation of field activities, insights, and metrics in required systems • Contribute to development and refinement of MSL SOPs/guidance, metrics, and reporting processes • Promote best practices, standardization, and continuous improvement across all field medical

• Provides clinical leadership and direction to utilization & care management functions of Martin’s Point’s Health Plans • Works collaboratively with other plan functions that interface with Medical Management such as Health Management, Compliance and Appeals, Network Management, Member Services, benefits & claims management, and Compliance. • Assists in or drives short and long-range clinical programming, quality management, and external relationships. • Reports to the Vice President Health Plan Medical Director and works closely with other Health Plan leaders. • Responsible and accountable to the Health Plan Medical Director for helping to manage health plan medical costs by assuring clinically appropriate health care delivery for health plan products and services utilizing Evidence-Based Guidelines.