VP, Chief Medical Officer, Medicare

Blue Shield of CA; Oakland (CA); On-site; USD 150,000 - 220,000; Full time

Job summary

An established industry player is seeking a visionary VP, CMO for Medicare to lead medical oversight and ensure quality healthcare delivery across various Medicare product lines. This role demands strategic thinking and strong leadership to foster partnerships with key stakeholders, including the Medicare team and delivery system partners. The ideal candidate will have a robust background in clinical oversight and a track record of managing relationships within integrated health systems. Join this innovative firm to make a significant impact on healthcare services and drive performance excellence.

Qualifications

• Proven track record in clinical oversight and outcome-based performance.
• Experience in implementing clinical programs within delivery systems.

Responsibilities

• Provide medical oversight and leadership for Medicare product lines.
• Collaborate with cross-functional leaders to enhance Medicare performance.

Skills

Strategic Thinking

Leadership

Clinical Oversight

Utilization Management

Pharmacy Management

Outcome-based Performance

Education

MD or equivalent

MBA or relevant management degree

Job description

Your Role

The VP, CMO, Medicare is accountable for providing medical oversight, expertise, and leadership to ensure the delivery of affordable, quality healthcare services across all Medicare product lines (Individual, Group, PPO). The role requires strong partnerships with the General Manager of the Medicare team, the Quality team, the Encounter team, Network Management, and other cross-functional leaders impacting Medicare performance. It also involves close oversight of the UM and CM teams within BSC and collaboration with delivery system partners responsible for clinical and administrative functions. The VP CMO, Medicare must have strong influencing skills and leadership qualities to establish and maintain provider partnerships, leveraging insights from both health plan and delivery system infrastructures.

The ideal candidate will think strategically, demonstrate strong leadership and management skills, and have a proven track record in clinical oversight and outcome-based performance. They should understand key components such as accurate and timely risk score submission, Medicare revenue and costs, utilization management, case management, pharmacy management, and Medicare Stars performance. Experience in implementing clinical programs within delivery systems and managing relationships with IPAs, medical groups, and integrated health systems is essential.