Market CMO

Amerihealth Caritas•Edgmont Township, PA

22h•Hybrid

About The Position

The Market Chief Medical Officer (CMO) is a member of the market leadership team and reports directly to the CHC Market President/CEO, with a dotted-line reporting relationship to the National Chief Medical Officer. The role provides market-based clinical leadership, including developing and executing health care affordability and clinical quality initiatives to achieve goals. The Market CMO is accountable for initiatives to improve HEDIS, pay-for-performance, LTSS, and other quality measures and ratings. The CMO collaborates with the local provider community and state regulatory agencies to improve care and strengthen external relationships, and contributes to overall health plan performance, including service coordinator staff development. This seasoned professional engages with the Plan’s stakeholders to advance clinical excellence and cost-efficient care while building a network of supportive partners. The work arrangement is Monday through Friday, 8:30 AM to 5:00 PM EST, with two to three days per week in the office in Harrisburg, PA, or Newtown Square, PA. Candidates local to the Greater Philadelphia area are preferred.

Requirements

At least five years of active clinical practice in a medical specialty such as OBGYN, pediatrics, internal medicine, family practice, or a surgical discipline.
At least five years of progressive leadership in medical management.
Active, unencumbered Pennsylvania license to practice medicine.
Valid driver’s license and car insurance.
Ability to lead clinical, quality, and operational teams in direct and matrixed environments.
Experience working across multiple lines of business, including Medicaid, Medicare, and ACA/Exchange.
Knowledge of the health needs of diverse, low-income populations.
Strong decision-making skills and ability to develop and execute strategic initiatives.
Advanced analytical capabilities focused on population health and cost-of-care outcomes.
Excellent verbal and written communication skills, including the ability to convey complex clinical and operational concepts clearly.
Ability to build effective relationships across organizational levels, including with providers, regulatory agencies, and internal stakeholders.
Skill in leveraging technology and data analytics to support clinical and operational performance.

Nice To Haves

Prior experience as a Medical Director or Chief Medical Officer within a managed care organization.
Experience with quality improvement methodologies such as IHI, Lean, or Six Sigma.
Local to the Greater Philadelphia area.

Responsibilities

Provide leadership for CHC LTSS medical management initiatives.
Ensure a high-performing utilization management system that follows the Covered Services specified in the Contract and uses evidence-based standards for coverage determinations.
Provide physician leadership for quality governance and quality-of-care reviews.
Serve as the Plan’s primary physician-level contact for the regulator’s Medical Director and support clinical escalations.
Oversee medical policy development and regulatory compliance.
Support provider network quality, adequacy, and access.
Collaborate with medical management, network contracting and provider relations, member services, claims management and payment integrity, pharmacy, and quality and risk adjustment teams.
Engage members, the physician community, health systems, nursing facilities, home and community-based networks, professional associations, government groups, and advocacy groups to advance clinical excellence and cost-efficient care.
Contribute to health plan performance, including service coordinator staff development.