Chief Medical Officer
About the Company
Highly-rated health insurance provider
Industry
Non-Profit Organization Management
Type
Privately Held
Founded
2011
Employees
51-200
Categories
About the Role
The Company is seeking a Chief Medical Officer (CMO) to serve as the senior clinical leader for its health plans. The CMO will be responsible for the oversight and strategic leadership of all medical management and quality functions, ensuring the delivery of high-quality, cost-effective care in compliance with state and federal regulations. This executive role involves leading a range of teams, including utilization management, concurrent review, case management, social work, community health workers, and the quality improvement department. The CMO will also be involved in the development and execution of care management strategies, particularly for low-income and high-risk populations, and will work closely with the System EVP & Chief Medical Officer to align clinical strategies with broader system-level goals. Applicants for the CMO position at the company must have a doctoral or professional degree in a postgraduate clinical specialty, with a minimum of 5 years of progressive leadership experience in medical management within a managed care or health plan environment. The role requires an in-depth knowledge of utilization management, case management, concurrent review, quality improvement, and population health management, as well as a demonstrated understanding of applicable HMO regulations and standards. The ideal candidate will be an outstanding clinician with strong clinical references, and must hold an M.D. or D.O. board-certified in a postgraduate clinical specialty, with a current unrestricted license from the Texas Medical Board. The CMO will also be responsible for clinical policy development, cross-department collaboration, staff leadership, and community engagement, and must ensure full compliance with regulatory and accreditation bodies.
Hiring Manager Title
CEO
Travel Percent
Less than 10%
Functions
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