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 collaboration with delivery system partners delegated for clinical and administrative functions. The VP CMO, Medicare must have strong influencing skills and the ability to establish and maintain provider partnerships, with insights into both health plan and delivery system infrastructure.
The ideal candidate will think strategically, possess strong leadership and management skills, and have a proven track record in clinical oversight and outcome-based performance. They should understand the submission of risk scores through encounter data, Medicare revenue and costs related to utilization management, case management, pharmacy management, Medicare Stars, and have experience implementing clinical programs into delivery systems, managing relationships with IPAs, medical groups, and integrated health systems.
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