Executive CMO — Medicare Advantage & SNP Strategy

Abilis Health Plan; Louisville (KY); On-site; USD 250,000 - 450,000; Full time

Job summary

Abilis Health Plan seeks a Chief Medical Officer to provide executive clinical leadership for its Medicare Advantage SNP/IE-SNP products and associated programs. The CMO will guide utilization management, quality, population health, and pharmacy operations to deliver safe, effective, and financially responsible care in long‑term care settings.

The role partners with the CEO and leadership team to drive clinical performance, regulatory compliance, and an integrated model of care for high‑acuity

Qualifications

• MD or DO required with board certification in an appropriate specialty.
• Completion of an accredited residency program.
• Active, unrestricted medical license in at least one operating state.
• 7–10 years of clinical practice with 3–5 years in health plan or population health leadership.
• Experience with Medicare Advantage or Special Needs Plans preferred.

Responsibilities

• Provide overall clinical leadership for plan products and clinical strategy.
• Oversee utilization management, medical necessity determinations, and appeals.
• Lead clinical operations, care management, and transitional care.
• Collaborate with quality, Star ratings, and regulatory teams on improvements.
• Provide clinical oversight of pharmacy strategy and formulary input.
• Analyze clinical and performance data to identify trends and improvements.
• Partner with providers and facility leadership to ensure high‑quality care.
• Represent the plan with regulators and external stakeholders as chief clinical spokesperson.

Skills

Leadership

Communication

Analytical

Strategic thinking

Integrity

Education

MD/DO degree

Board certification

Residency completion

Job description

Abilis Health Plan seeks a Chief Medical Officer to provide executive clinical leadership for its Medicare Advantage SNP/IE-SNP products and associated programs. The CMO will guide utilization management, quality, population health, and pharmacy operations to deliver safe, effective, and financially responsible care in long‑term care settings.

The role partners with the CEO and leadership team to drive clinical performance, regulatory compliance, and an integrated model of care for high‑acuity