Remote CMO - Health Plan Clinical Leadership

Presbyterian; United States; Hybrid; USD 350,000 - 550,000; Full time

Benefits offered by this job

Competitive salary

Medical insurance (full)

FSAs

Wellness programs

PTO and leave policies

Retirement plans with employer match

Education and career development

Life and disability insurance

Job summary

Presbyterian Healthcare Services seeks a Chief Medical Officer to lead clinical strategy, medical policy, and utilization management across a major health plan and provider network. You will oversee medical directors, drive evidence-based decisions, and engage with physicians and stakeholders to ensure high-quality, affordable care.

The role requires extensive leadership experience, board certification, and an active New Mexico medical license, with a focus on policy development, risk

Qualifications

• MD or 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, and regulatory requirements.
• Strong physician leadership, executive communication, and business acumen.

Responsibilities

• Serve as the senior physician executive for the health plan.
• Lead Medical Directors and UM staff including clinicians and reviewers.
• Provide clinical leadership across affordability, quality, utilization, access, and population health.
• Advise executive leadership on clinical risk and cost drivers.
• Represent the health plan in physician and regulatory forums.
• Oversee UM medical necessity decision making and appeals processes.
• Maintain governance for medical policies and clinical criteria.

Skills

Executive leadership

Medical leadership

Executive communication

Population health

Education

MD or DO

Board certification

Active NM medical license

Advanced degree (MBA/MHA/MPH/MMM)

Job description

Presbyterian Healthcare Services seeks a Chief Medical Officer to lead clinical strategy, medical policy, and utilization management across a major health plan and provider network. You will oversee medical directors, drive evidence-based decisions, and engage with physicians and stakeholders to ensure high-quality, affordable care.

The role requires extensive leadership experience, board certification, and an active New Mexico medical license, with a focus on policy development, risk