Chief Medical Officer, Population Health Services and Health Plan Operations

We are so glad you are interested in joining Sutter Health!

Organization:

SHSO-Administrative Payroll

Position Overview:

About Sutter Health:

Sutter Health is a leading not-for-profit healthcare system in Northern California, serving over 3.5 million patients through a network of hospitals, clinics, and care services. With a legacy of more than 100 years, our 57,000+ employees and 12,000+ physicians are united by a mission to care for our patients first—and our people always.

About this opportunity:

The Chief Medical Officer (CMO), Population Health Services and Health Plan Operations, is a senior executive responsible for providing strategic and clinical leadership across Sutter’s value-based care initiatives, Sutter Health Plan, and integrated delivery networks. This role leads the development and execution of population health strategies, clinical quality programs, and care model innovation to drive improved outcomes, cost-effective care, and performance on key metrics such as CMS Stars and HEDIS.

The CMO provides clinical oversight and direction for critical health plan functions—including utilization management, credentialing, authorizations, concurrent review, and elements of claims review—ensuring that these processes are evidence-based, compliant, and aligned with quality and affordability goals. The CMO is dually partnered in dyadic pairings with administrative leaders over population health services and plan operations, respectively, and serves as a key clinical partner to cross-functional value-based care-focused leaders in finance, analytics-informatics, and plan-product design to ensure cohesive, clinically sound strategies across the organization. Physician leaders contributing to the management of population health and plan functions will report to this role.

Job Description:

Education: 

• MD or DO degree from an accredited medical school. 

• Board certification in a primary care specialty (e.g., Internal Medicine, Family Medicine) or relevant sub-specialty. 

• Active, unrestricted medical license in the state(s) of practice. 

 

Experience: 

• 10+ years of progressive leadership in clinical operations, population health, or value-based care environments. 

• Demonstrated success in managing Medicare Advantage or other risk-based contracts. 

• Proven history of leading large multidisciplinary teams in care management, utilization management, and quality improvement. 

• Proven history in population health management, risk adjustment, and quality measurement (HEDIS, CMS Stars). 

• Experience managing utilization management, credentialing, authorization processes, and concurrent review in a plan or health system context. 

• Experience collaborating with payors, provider networks, and health plan leadership. 

 

Knowledge: 

• In-depth understanding of CMS Stars, HEDIS, and regulatory requirements for Medicare Advantage and commercial plans. 

• Expertise in risk-adjustment methodologies and clinical documentation accuracy. 

• Familiarity with data analytics platforms and machine-learning inputs for clinical decision support. 

• Comprehensive knowledge of care management models, including complex and chronic disease management. 

• Strong grasp of transitions-of-care coordination best practices. 

• Proficiency in utilization management processes: authorizations, concurrent review, and medical necessity criteria. 

• Thorough understanding of credentialing standards and compliance requirements. 

• Awareness of palliative care principles and program implementation. 

• Deep experience in leading and sca