Associate Chief Medical Officer for Managed Care Greater San Jose, CA Area

Stanford University School of Medicine seeks an Associate Chief Medical Officer (ACMO) for Managed Care, with an academic appointment in the Clinician Educator line. The primary criterion for appointment is excellence in a combination of clinical care, teaching, administration, and/or scholarship aligned with the programmatic needs the individual is expected to fulfill.

The ACMO is a physician executive responsible for leading Stanford Medicine Children’s Health’s payer strategy, reimbursement, and access to destination services. The ACMO partners with clinical, operational, and executive leaders to optimize payer relationships, support utilization strategies, improve access to specialized pediatric services, and advance organizational goals related to financial performance and patient experience.

The ACMO serves as a key physician leader for complex payer, authorization, medical necessity, and reimbursement matters; provides clinical oversight and consultation across revenue cycle, utilization management, and care coordination; and fosters physician engagement through education and guidance on best practices to mitigate denials and safeguard reimbursement. As a member of the Senior Leadership Team, the ACMO provides leadership for strategic programs and partnerships that support Stanford Children's mission and long-term growth.

Essential Functions

Payer Strategy and Contracting

• Provide clinical leadership for payer contracts and denial management strategies.
• Cultivate relationships with health plan clinical and administrative leaders, including medical directors and executives.
• Partner with payers and SMCH stakeholders to resolve complex coverage, reimbursement, and access issues, including facilitation of Letters of Agreement (LOAs) and single-case agreements.
• Collaborate with internal and external stakeholders to improve patient access to specialized pediatric services.
• Assist with analysis of reimbursement performance across all payers to identify and prioritize improvement opportunities.

Clinical Oversight for Revenue Cycle, Utilization and Care Coordination

• Provide physician consultation and oversight for complex utilization management, medical necessity, and care coordination issues.
• Serve as executive escalation point and provide physician consultation on complex financial clearance, authorization, reimbursement, and denial issues for both in-network and out-of-network health plans (including out-of-state Medicaid plans.)
• Partner with Revenue Cycle, Managed Care, Case Management, and Utilization Review teams to address payer challenges and improve reimbursement outcomes.
• Identify denial trends and opportunities to improve access to care, financial clearance, and reimbursement.
• Oversee the Stanford Children’s International Patient Services (SCIPS) program for assisting international families seeking elective care at SMCH.
• Provide oversight to a team of assigned medical directors working in Case Management, UM, CDI, HIMS, financial clearance and other medical directors as assigned.

Physician Education and Clinical Consultation

• In partnership with Revenue Cycle Operations, serve as the physician resource for questions, issues, and escalations regarding regulatory and payer requirements for coverage of medically necessary services, financial clearance, and reimbursement.
• Educate and coach physicians on documentation, authorization requirements, and payer expectations / guidelines.
• Work with operational and clinical leaders to develop guidance and best practices to improve authorization approvals and reduce administrative barriers to care.
• Provide guidance to physicians on complex payer, utilization, and access-related issues.

Executive and Organizational Leadership

• Serve on the Stanford Children's Health Senior Leadership Team.
• Provide clinical leadership for Stanford Health Care Alliance (SHCA) insurance product.
• Oversee LPCH Case Management functions from Physician-Nurse Dyad perspective and provide UM expertise to that team and Co-Chair Medical Staff Utilization Review Committee
• Lead Stanford Children's International Patient Services (SCIPS).
• Serve on SMCH Corporate Compliance Committee
• Serve on SMCH Committee on Management Controls & Compliance (CMCC)
• Serve on relevant SMCH committees such as Effectiveness & Efficiency Oversight, Access Steering, Grievance Payer Strategy, Payer Performance, Cell and Gene Therapy Executive Committee
• Assist with relevant issues discussed at health plan JOC meetings
• Facilitate the cardiovascular financial clearance review meetings.
• Be a resource as needed to solid and stem cell transplant as well as gene therapy financial clearance review teams and meetings.
• Chair the High-Cost Drug Committee and provide guidance on unique high-cost therapies.

Qualifications

Minimum

• MD/DO (or equivalent)
• 5+ years’ experience in physician leadership roles in health plans, hospitals, health care systems or equivalent
• CA Medical License will be required upon hiring

Preferred

• Qualified to assume 25% clinical role in an academic pediatric and obstetric health system setting
• Advanced degree, such as MBA, MHA, or equivalent

Knowledge

Candidate would preferably have experience with:

• Pediatrics
• Maternity
• Epic
• Accountable Care entities
• Commercial insurance reimbursement
• Medicaid insurance reimbursement

To Apply

Submit CV and a letter of interest with an optional discussion of how your work and experience fosters additional dimensions to the university’s mission and value.

Stanford is an equal employment opportunity and affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by law. Stanford welcomes applications from all who would bring additional dimensions to the University’s research, teaching and clinical missions.

Consistent with its obligations under the law, the University will provide reasonable accommodations to applicants and employees with disabilities. Applicants requiring a reasonable accommodation for any part of the application or hiring process should contact disability.access@stanford.edu [disability.access@stanford.edu].

The university’s central functions of research and education depend on freedom of thought, and expression. The School of Medicine and Stanford University value faculty who will help foster an open and respectful academic environment for colleagues, students, and staff with a wide range of backgrounds, identities, and perspectives. Candidates may choose to include as part of their research and teaching statements a brief discussion about how their work and experience will further these values.

For questions, please contact:

Dr. Mitchell B. Cohen

Elizabeth Wood Dunlevie Professor of Pediatrics

Chief Medical Officer, Stanford Medicine Children’s Health

Senior Associate Dean for Maternal and Child Health, Stanford Medicine

mcohen3@stanford.edu [mcohen3@stanford.edu]

The expected base pay range for this position is $515,000 - $555,000 (at 1.0 FTE).

This pay range reflects base pay and an ACMO administrative supplement, which is based on faculty rank and years in rank. It does not include all components of the School of Medicine’s faculty compensation program including pay from participation in departmental incentive compensation programs. For more information about compensation and our wide-range of benefits, including housing assistance, please contact the hiring department.