Chief Medical Officer

State of Oklahoma

About The Position

The Oklahoma Health Care Authority (OHCA) works to ensure Oklahomans have access to better health and better care. The agency’s core values include passion for purpose, trust and transparency, empowerment and accountability, best in class and outcome-driven, and servant leadership. As part of the interview process, candidates may be required to attend an in-person interview at our Oklahoma City office. The Chief Medical Officer (CMO) serves as the senior clinical leader responsible for the oversight, direction, and continuous improvement of the agency’s medical functions across the Medicaid program and the HealthChoice / Employees Group Insurance Division (EGID). As a licensed Medical Doctor (MD) or Doctor of Osteopathy (DO), the CMO provides strategic clinical leadership and medical expertise to ensure the quality, effectiveness, accountability, and regulatory compliance of medical services. Working in close coordination with executive leadership, the CMO directs medical policy development, clinical guidelines, and operational strategies to advance health care delivery, program innovation, and system integrity. This role ensures that covered services and medical practices align with accepted standards of care, statutory and regulatory requirements, agency goals, and fiscal stewardship, while optimizing health outcomes for members and supporting sustainable, cost-effective programs.

Requirements

To be considered for this position your application must include a resume/CV with complete work and education history.
A bachelor’s degree in public health or health related degree, business administration or a closely related field AND
Current license to practice medicine as a Medical Doctor (MD) or Doctor of Osteopathy (DO) in the state of Oklahoma and recognized by national regulatory bodies in the US AND
Minimum of 5-10 years of postgraduate experience in direct patient care with progressively more responsibility in a health care setting AND
Be board certified by an appropriate specialty college or program (or DO equivalent) AND
Three (3) years of medical management or supervisory experience as a medical professional.
AND Current active state license with DEA privileges; if not fully licensed in OK, must complete licensing in OK within 6 months of hire
AND Must remain up to date with annual, continuing education requirements

Nice To Haves

ABMS Board Certification
MD/DO License with at least 10 years’ experience
Advanced management degree (MBA, MPH, MPM, or related degree)
Working knowledge of CPT/HCPCS coding
Work experience as a Medical Director
Supervisory and leadership experience
Capable of effectively communicating and motivating associates at all levels of the organization, including executive staff
Experience in implementing utilization and quality improvement strategies/techniques and experience with physician behavior modification
Experience in developing medical policy, procedures and programs
Excellent public/physician relations

Responsibilities

Medical Oversight and Clinical Guidance: Provide expert medical review and executive-level clinical leadership for utilization management, case management, medical necessity determinations, appeals, quality improvement, program integrity, and policy development activities. Ensure all medical determinations meet accepted standards of care, evidence-based guidelines, and applicable federal and state requirements.
Strategic Planning and Operational Leadership: Lead the development and execution of divisional goals; adjust operational strategies to enhance program performance; supervise professional staff; and systematically evaluate division operations to implement improvements in efficiency, effectiveness, and fiscal accountability.
Policy Interpretation, Development, and Regulatory Alignment: Interpret federal and state legislation and regulations affecting medical, behavioral health, dental, and pharmacy policy. Provide regular clinical and strategic input on the potential impact of policy and operational decisions on health care delivery. Advise internal leadership and collaborate with OMES/EGID, actuaries, and other partners to assess statutory and regulatory impacts on benefits and programs.
Medical Management and Systems Oversight: Oversee medical management activities, including utilization review, determinations of medical necessity, coverage decisions, exceptions to network care, and review of novel or emerging treatment requests. Provide clinical direction and oversight for Medicaid Management Information System (MMIS), claims editing, and fraud, waste, and abuse detection systems to ensure consistent application of medical policy.
Quality and Performance Management: Administer performance standards with measurable criteria to ensure compliance with laws, policies, and clinical best practices. Oversee quality assurance, performance improvement initiatives, External Quality Review Organization (EQRO) activities, and quality oversight committees. Establish benchmarks to promote continuous improvement and excellence in service delivery.
Leadership, Supervision, and Knowledge Transfer: Lead, mentor, and supervise Medical and Dental Directors, consultants, and clinical and administrative staff. Identify training needs, support professional development, and foster a culture of continuous learning and accountability to maintain current medical knowledge and elevate team performance.
Stakeholder Engagement and Representation: Partner with internal and external stakeholders to align programs with state and federal requirements, support quality improvement, and advance innovation. Represent the agency at state and national meetings, task forces, legislative activities, and collaborative partnerships to promote evidence-based care and strengthen agency outcomes.
Clinical Authority and Licensure: Exercise independent clinical judgment in medical determinations, appeals, and coverage decisions. Maintain a current Oklahoma MD or DO license as required to fulfill assigned responsibilities
Other duties as assigned.

Benefits

Generous state-paid benefit allowance to offset insurance premiums.
A wide selection of insurance plans with no pre-existing condition exclusions.
Flexible Spending Accounts for health care and dependent care.
Retirement Savings Plan with employer contributions.
11 paid holidays annually.
15 days of vacation and 15 days of sick leave in the first year.
Longevity Bonus recognizing years of public service.
Public Service Loan Forgiveness eligibility and tuition reimbursement.
Wellness benefits, including an on-site gym and fitness center discounts.
Generous state-paid benefit allowance to offset insurance premiums.
A wide selection of top-tier health insurance plans.
Optional flexible spending accounts for health care or dependent care expenses.
Employee Assistance Program (EAP) offering confidential support.
Wellness benefits, including an on-site gym and fitness center discounts.
11 paid holidays annually.
15 vacation days and 15 sick days in your first year.
Retirement Savings Plan with substantial employer contributions.
Longevity Bonus to reward years of service.
Public Service Loan Forgiveness eligibility and reimbursement for educational expenses.
Professional development training opportunities, including CEU support.