Executive CMO: Medicare Advantage Clinical Strategy

Abilis Health Plan; Louisville (KY); Vor Ort; USD 250.000 - 360.000; Vollzeit

Zusammenfassung

Abilis Health Plan seeks a Chief Medical Officer to provide executive clinical leadership for its I-SNP/IE-SNP Medicare Advantage programs in long term care settings. You will partner with the CEO to shape clinical strategy, drive quality, utilization management, and regulatory compliance across populations with high acuity and complex needs.

Responsibilities include directing clinical operations, Stars and quality initiatives, collaboration with network physicians, and ensuring safe, effective,

Qualifikationen

• MD or DO required and board certified.
• Residency completed in an accredited program.
• Minimum 7–10 years clinical practice with 3–5 years in health plan or population health leadership.
• Experience leading utilization management, quality improvement, and care management.
• Experience with Medicare Advantage or SNPs preferred.
• Leadership experience with long term care or institutional populations preferred.
• Active, unrestricted medical license in at least one operating state (KY, TN).
• Strong knowledge of CMS regulations and compliance requirements.

Aufgaben

• Provide executive clinical leadership for the plans and product strategy.
• Oversee utilization management, medical necessity determinations, and appeals.
• Lead clinical operations, care management, and interdisciplinary teams.
• Collaborate on Stars strategy, quality initiatives, and corrective action plans.
• Oversee pharmacy strategy and formulary design input.
• Review data to identify trends and opportunities for improvement.
• Collaborate with network physicians and facility leadership to ensure high quality care.
• Ensure regulatory compliance and audit readiness.
• Participate in strategic planning and growth initiatives at the executive level.
• Represent the plan with regulators and external partners.

Kenntnisse

Executive leadership

Analytical skills

Regulatory knowledge

Strategic planning

Communication

Ausbildung

MD/DO degree

Residency completed

Board certification

Tools

CMS regulations

STARs/HEDIS knowledge

Jobbeschreibung

Abilis Health Plan seeks a Chief Medical Officer to provide executive clinical leadership for its I-SNP/IE-SNP Medicare Advantage programs in long term care settings. You will partner with the CEO to shape clinical strategy, drive quality, utilization management, and regulatory compliance across populations with high acuity and complex needs.

Responsibilities include directing clinical operations, Stars and quality initiatives, collaboration with network physicians, and ensuring safe, effective,