Hybrid CMO, ACA Health Plans & Quality

Antidote Health Group; New York (NY); Hybrid; USD 350,000 - 380,000; Full time

Benefits offered by this job

Equity

401(k)

Paid vacation and holidays

Job summary

Antidote Health is seeking a Chief Medical Officer for a hybrid NYC-based role to lead Clinical Operations, Quality, and strategic initiatives across ACA Marketplace plans. You will drive clinical excellence, risk management, and cost-control while guiding technology-enabled care improvements for members.

The ideal candidate has a proven track record in health plan leadership, regulatory expertise, and a strong track record of balancing clinical quality with financial performance.

Qualifications

• MD or DO degree from an accredited medical institution.
• Active, unrestricted license to practice medicine in at least one U.S. state.
• Board certification in a recognized medical specialty.
• Minimum of 10 years of experience within a U.S. health plan or managed care organization, including at least five years in a senior physician leadership or executive capacity.
• Hands-on ability to operate in a fast-paced startup environment, balancing strategic leadership with direct execution.
• Leadership experience within commercial health insurance, preferably ACA Marketplace/QHP operations.
• Extensive knowledge of health plan clinical operations including UM, CM, DM, Behavioral Health, Population Health, and quality improvement.
• Experience with NCQA accreditation, HEDIS measures, and health plan quality reporting requirements.
• Experience overseeing delegated clinical vendors, ensuring regulatory and contractual compliance.
• Demonstrated success integrating emerging technologies into healthcare operations with measurable ROI, including AI-enabled workflows, automation, and data analytics.

Responsibilities

• Serve as a member of the executive leadership team, contributing to enterprise strategy, business performance, organizational priorities, and long-term growth.
• Balance clinical quality with financial sustainability, operational efficiency, and member experience.
• Lead Clinical Operations and Quality oversight with regulatory compliance.
• Oversee PBM and pharmacy programs including formulary development and cost-improvement initiatives.
• Partner with Finance, Actuarial, Network Management, Pharmacy, Technology, Product, Compliance, Legal, and other functions to align clinical strategies with enterprise objectives.
• Communicate strategic priorities and performance results to the executive team and Board.
• Drive technology-enabled clinical transformation and interoperability, including AI and decision-support systems.

Skills

Leadership

Strategy

Financial acumen

AI in healthcare

Collaboration

Education

MD/DO degree

Tools

QNXT platform

MCG criteria

Job description

Antidote Health is seeking a Chief Medical Officer for a hybrid NYC-based role to lead Clinical Operations, Quality, and strategic initiatives across ACA Marketplace plans. You will drive clinical excellence, risk management, and cost-control while guiding technology-enabled care improvements for members.

The ideal candidate has a proven track record in health plan leadership, regulatory expertise, and a strong track record of balancing clinical quality with financial performance.