Chief Medical Officer - Remote Health Plan Leadership

MedicalVirtual; Albuquerque (NM); Hybrid; USD 350,000 - 550,000; Full time

Benefits offered by this job

Competitive salaries

Full medical, dental and vision

FSAs

PTO

Retirement plans

Continuing education and career growth

Life insurance and disability programs

Job summary

Presbyterian Healthcare Services seeks a Chief Medical Officer to provide senior clinical leadership for the health plan, setting medical policy, clinical strategy, and governance of criteria and utilization decisions. You will oversee medical necessity determinations, appeals, peer reviews, and provider engagement to align care quality with regulatory standards.

The role emphasizes collaboration with the Healthcare Value Leader and cross-functional leaders to optimize population health, cost

Qualifications

• MD/DO from an accredited medical school.
• Active, unrestricted medical license – New Mexico.
• Board certification.
• 10+ years of relevant clinical and health care leadership experience.
• Experience with medical necessity review, appeals, peer review, clinical criteria, medical policy, and regulatory/accreditation requirements.

Responsibilities

• Serve as the senior physician executive for Presbyterian Healthcare Services.
• Lead Medical Directors and UM staff, including clinicians and reviewers.
• Provide clinical leadership across affordability, quality, utilization, access, and population health.

Skills

Clinical leadership

Medical policy

Regulatory compliance

Executive communication

Population health

Cost/utilization analysis

Education

MD/DO

Board certification

Job description

Presbyterian Healthcare Services seeks a Chief Medical Officer to provide senior clinical leadership for the health plan, setting medical policy, clinical strategy, and governance of criteria and utilization decisions. You will oversee medical necessity determinations, appeals, peer reviews, and provider engagement to align care quality with regulatory standards.

The role emphasizes collaboration with the Healthcare Value Leader and cross-functional leaders to optimize population health, cost