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 delegated for clinical and administrative functions. The VP CMO, Medicare must have strong influencing skills and leadership qualities to establish and maintain provider partnerships, with insights into both health plan and delivery system infrastructure.

The candidate should think strategically, demonstrate strong leadership and management skills, and have a proven track record of clinical oversight and outcome-based performance. Essential knowledge includes accurate and timely submission of risk scores through encounter data, Medicare revenue and costs, utilization management, case management, pharmacy management, Medicare Stars experience, and implementing clinical programs into delivery systems. Experience in managing relationships with IPAs, medical groups, and integrated health systems is also crucial.

Your Knowledge and Experience

• Medical degree (M.D./D.O.)
• Residency preferably in adult primary care specialties such as internal medicine or family practice
• Active, unrestricted California Medical License
• At least 12 years of relevant experience, including 5 years in managed care and 5 years in leadership roles
• Prior experience as a Regional Medical Director in a health plan
• Experience with Medicare Stars program (HEDIS, HOS, CAHPS)
• Experience with the Delegated Model
• IPA/Medical Group experience with over 100,000 enrollees, including practice change and clinical intervention roles
• Clinical work in Internal Medicine, Family Practice, Pediatrics, or Emergency Medicine
• Understanding of the California marketplace
• Experience with Accountable Care Organizations
• Excellent communication skillsverbal, written, presentation, and facilitationable to convey complex information clearly
• Proven leadership in developing and managing high-performing teams
• Strong critical thinking skills

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