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Chief Medical Officer

Job Posting
Chief Medical Officer
Job Details
Job Type


Greensboro, NC • UM Care Management
Job Summary

The Chief Medical Officer (CMO) is responsible for all areas of medical management, including but not limited to, utilization management, care management, quality management, medical policy development, medical informatics, and creating and implementing a market-leading framework for population health, including health equity, to achieve company goals of providing affordable and high-quality care. The CMO will work across all areas where physician input is needed. The CMO will also work with the Chief Executive Officer and other executives helping to formulate, facilitate and communicate the company’s strategic initiatives and future goals.

Major Work Activities

Works with CEO to establish an annual budget, medical expense, and administrative budget for board approval.
Provides clinical leadership in the development, organization, and governance of the health plan in all markets served.
Prepare and present quarterly board medical management package and provide information and analysis as requested by board members or other key executives
Chairs the medical and quality management committees of the company
Is the key executive responsible for ensuring a collaborative and positive relationship with the company’s physician community and ensuring the strong and collaborative partnerships to identify strategies for high quality and better member outcomes and meeting company performance
Responsible for leading the improvement of clinical outcomes for the health plan and operating partnerships.
Presents performance data at a market, line of business, physician group, and physician level to the providers in the market.
Provides change management expertise in health systems, provider organizations, and physician practices
Participates in the alignment of physician incentives, quality measures, and value-based contracts.
Develops, monitors, and executes short- and long-term tactical and strategic plans, engaging leaders, and respective departments on care management, utilization, and part C quality management, population health, health equity to provide overall direction to ensure programs and services are provided in accordance with standards established through state and federal regulations, including the Center for Medicare and Medicaid Services, and other relevant agencies
Review and analyze medical information and quality metrics and make recommendations for programs and processes to improve member outcomes and prioritize the deployment of programs and process improvement efforts to achieve company goals, including Medicare Star Measures and accurate coding
Fosters relationships across all health plan partners (including clinical pharmacists, medical directors in partnering organizations, and primary care physicians) to educate and better collaborate on quality outcomes, formulary optimization, utilization trends and opportunities for improvement.
Works with the executive team towards optimization of Plan provider engagement model, technologies, care delivery, and business processes
Works with the Chief Executive Officer and other executives to coordinate planning and establish priorities for the planning process
Studies long-range economic trends, including, but not limited to the delivery of healthcare, and projects their impact on future growth in sales and market share
Identifies opportunities for expansion into new product areas
Perform peer review and validate quality data assessments, ROI of interventions, program evaluations, process improvement projects, or other reports or submissions that impact the plan STAR ratings or other metrics that may impact premium, decisions to expand or extend interventions
Oversees medical trend analysis and reporting
Develops medical cost improvements in collaboration with the Chief Executive Officer and leaders and tools to measure the effectiveness
Manage and supervise assigned staff and intercompany support relationships to accomplish the goals of the Company
Other duties as assigned


Minimum Qualifications

Required Education

Doctor of Allopathic Medicine (MD) or Doctor of Osteopathic Medicine (DO)
Board-certified in internal medicine, family medicine, or geriatrics approved by the American Board of Medical Specialties (ABMS) or the American Osteopathic Association Bureau of Osteopathic Specialists (AOABOS) from the major areas of clinical services
Required Licensure/Certification

Valid License in North Carolina (or ability to sit for licensure within an agreed-upon time frame)
Annual Flu Vaccine
COVID-19 Vaccine
Required Experience and Knowledge

Eight or more years’ progressive experience in medical management or population health management
Strong knowledge of clinical care industry standards
Highly proficient knowledge of Medicare Advantage, including the Stars program, risk adjustment, HEDIS, CAPHS, HOS, and NCQA
Highly proficient experience in strategic planning
Strong knowledge of value-based care and contracting
Experience working in the healthcare industry, the insurance industry, or pharmacy benefit manager
Required Skills and Abilities

Excellent written and verbal communication in one-on-one settings in in public
Highly effective at building rapport, credibility, and trust across multiple audiences
Strong leadership practices that include monitoring performance and coaching
Analytical and organizational skills
Strong decision making and problem-solving skills
Ability to foster relationships internal and external to the company
Executive skill set and emotional intelligence
Proficient in business software (e.g., MS Office products)
Preferred Qualifications

Preferred Education

Master’s degree in business or related field

Time:  Full time
Salary:  Salary
Category:  Clinical/pharmacy/quality

Updated: 5/4/2022 2:49:20 PM

Job Contact:
Michael Abner

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7800 McCloud Road
Greensboro, NC 27409