Chief Medical Officer (CMO), Medicare Advantage Plan

 Clover is reinventing health insurance by working to keep people healthier.

We are seeking a highly skilled and experienced Chief Medical Officer (CMO) to report to our CEO, Medicare Advantage. You will play a critical role in shaping and executing the medical strategy for the health plan, ensuring the delivery of high-quality care, and driving innovation within our Medicare Advantage program.

As a Chief Medical Officer, you will:

Strategic Leadership:

• Provide strategic direction and leadership for the medical aspects of the Medicare Advantage Plan.
• Collaborate with executive leadership to develop and execute a comprehensive medical strategy aligned with organizational goals.

Clinical Quality and Performance:

• Oversee the development and implementation of clinical quality improvement initiatives.
• Monitor and evaluate the performance of medical services to ensure compliance with regulatory standards and quality benchmarks.

Network Development and Management:

• Collaborate with network development teams to establish and maintain a high-performing provider network.
• Work closely with contracted providers to ensure seamless and coordinated care delivery.

Risk Management and Compliance:

• Assess and mitigate medical and clinical risks associated with the Medicare Advantage program.
• Ensure compliance with all relevant regulations, guidelines, and accreditation standards.

Innovation and Program Development:

•  Lead initiatives to enhance and innovate care delivery models within the Medicare Advantage framework.
• Identify opportunities for program expansion and improvement based on emerging healthcare trends and best practices.

Data Analytics and Population Health:

• Utilize data analytics to inform decision-making and drive improvements in population health outcomes.
• Work with analytics teams to develop and implement data-driven strategies for proactive healthcare management.

Collaboration and Communication:

• Foster strong relationships with internal stakeholders, including executive leadership, operations, and finance teams.
• Represent the organization in external forums, fostering collaboration with key partners, regulators, and industry stakeholders.

Clinical Governance:

• Establish and maintain clinical governance structures to ensure effective oversight of medical activities.
• Collaborate with interdisciplinary teams to enhance care coordination and patient outcomes.

You will love this job if:

• You are passionate about advancing clinical outcomes through technology,  home-based care, and care model transformation.
• You love program building across geographies.
• You are outcomes-oriented and driven to achieve results. You are motivated by complex scenarios and enjoy rapidly processing information and distilling it down into actionable goals.
• You have strong analytical and problem solving skills, along with a high level of attention to detail.
• You are great at prioritizing and executing multiple tasks that adhere to strict deadlines in a fast-paced, changing environment.
• You have excellent written and oral communications skills, including the ability to work collaboratively and build strong relationships across the organization.

You should get in touch if:

• You are a Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) with an active, unrestricted medical license with extensive experience in managed care, Medicare Advantage, or a similar healthcare environment.
• You are board-certified in internal medicine, family medicine, or other primary care specialty.
• You have demonstrated leadership experience (5 years) in a CMO or equivalent role along with a strong understanding of healthcare regulations, quality improvement, and risk management.
• You have a strong execution mindset with the ability to hold others accountable to high performance standards.
• You are technology savvy and have experience communicating cross-functionally with patients and colleagues.

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