The mission of the U.S. Department of Health and Human Services (DHHS) is to enhance and protect the health and well-being of all Americans. In Maine, DHHS serves approximately one-third of the state’s population, providing health care and social service support to children, families, the elderly, the disabled, people with mental illness or substance abuse issues, and the poor. MaineCare is a federal and state funded public health insurance program run by Maine’s DHHS which pays the medical expenses of people who are unable to pay some or all of their own medical expenses. The Office of MaineCare Services (OMS) works collaboratively with the Office of the Governor on health reform and coordinates with other health plans on statewide healthcare improvement initiatives. OMS assures that the health care programs and services it administers operate in line with Department goals, federal mandates, and State policy.
The Chief Medical Officer, MaineCare provides guidance for internal decision-making as part of the MaineCare senior management team and the healthcare management unit. The ideal candidate will have leadership experience in healthcare payment systems, pay for performance initiatives, medical necessity criteria, and federal and state quality improvement programs. The candidate should also possess experience serving Medicaid patients. The Chief Medical Officer, MaineCare offers direct clinical input on the direction of policy development, follows best practices, and provides information related to emerging practice trends, new technologies, and groundbreaking research. The Chief Medical Officer, MaineCare develops and maintains relationships with the provider community and other professional organizations. The Chief Medical Officer, MaineCare will be the office’s clinical representative with external partners, governmental departments, and stakeholders, such as pharmacy, dental, nursing, and other medical organizations and committees or associations. The Chief Medical Officer, MaineCare ensures that appropriate medical necessity decision-making standards are applied for all medical programs.
- Board certification in psychiatry, pediatrics, family medicine, or internal medicine is preferred. Consideration will also be given to physicians in relevant specialties, such as OB/GYN and candidates must have significant clinical experience.
- Experience in managed care, including utilization management and quality improvement is desirable. However, administrative experience in an alternative setting such as a hospital system or state Medicaid agency will be considered.
- Familiarity with the design and operation of Medicaid.
- Excellent oral and written communication skills; strong organizational, time management, interpersonal and computer skills.