Regional Chief Medical Officer

Summary

Job Description:

This role serves as a Regional Chief Medical Officer within the health plan, providing senior clinical leadership, community representation, and strategic oversight of medical operations. This highly visible role leads a team of Medical Directors and provides matrixed clinical influence across key Medical Services functions in the region. The role is the primary clinical executive for the region and brand, collaborating closely with the enterprise Chief Medical Officer to ensure alignment of clinical strategy, quality initiatives, and operational excellence in accordance with regulatory, accreditation, and corporate objectives. This leader builds trusted relationships with providers, hospital systems, regulators, and community partners to advance member outcomes, promote value-based care, and strengthen the organization's reputation in the market. This role blends clinical credibility with strong business acumen, ensuring clinical excellence, regulatory compliance, and financial stewardship across the organization.

Essential Accountabilities

• Serve as the regional and brand Chief Medical Officer, shaping and executing the clinical strategy for the market. Oversee and participate in the strategic planning, program development, and implementation for Medical Services related activities in partnership with executive leadership.
• Lead, coach, and develop a team of Medical Directors, fostering high performance, and member centered clinical culture. Provide clinical guidance, feedback, and professional development to physicians and clinical leaders.
• Represent the brand externally as the senior clinical voice in community forums, provider engagements, regulatory meetings, and public health partnerships. Serve as a liaison with our physician network to advance the mission of the plan for the benefit of its members.
• Partner with enterprise Chief Medical Officer to translate enterprise clinical priorities into regional programs and measurable outcomes. Support defined focus area by leveraging clinical expertise in alignment with corporate objectives and determined in partnership with enterprise Chief Medical Officer.
• Collaborate closely with Marketing & Growth and Provider Network & Contracting, to align clinical strategy with market strategies, jointly participating in regular engagement and alignment with key customers and groups.
• Contribute to the regional and enterprise strategy development. Collaborate with Finance, Operations and across the organization on budgeting, forecasting and performance metrics.
• Provide strategic clinical matrixed leadership and regional medical oversight to utilization management, case management, care management, quality, provider network, physician engagement, behavioral health, and health outcomes initiatives.
• Partners closely with CCP TASS and health care delivery support in alignment with organizational health care delivery goals.
• Champion regional quality strategy in partnership with Quality Leadership, including HEDIS, Stars, CAHPS, NCQA, and meeting state/regional quality requirements.
• Educate providers on clinical guidelines, quality metrics and population health strategies. Act as regional clinical representative in engagements with state regulators, CMS, and accreditation bodies.
• Ensure clinical operations comply with federal, state, and contractual requirements. Support enterprise risk management, audit processes, and corrective action plans.
• Ensure compliance with US Department of Labor, NYS regulatory and corporate appeals/grievance policy.
• Promote collaboration and alignment across multidisciplinary teams, ensuring clear accountability and clinical excellence. Influence cross functional teams using strong communication, relationship building, and executive presence without reliance on direct reporting lines.
• Oversee and monitor the administration of the division’s employment related activities in accordance with CDPHP’s policies and in a consistent and legally responsible manner including the principles of equal employment and affirmative action. Includes, but is not limited to the following: recruitment, selection, and hiring, training, development, retention, setting and monitoring standards of performance, promotions, transfers and terminations.
• The employee agrees to comply with CDPHP’s Corporate Compliance Policy and all laws, rules, regulations and standards of conduct relating to the Corporate Compliance Policy and has a duty and obligation to report any suspected violations of any law, the standards of conduct or Corporate Compliance Policy to his or her immediate Supervisor, the fraud and abuse hotline, the Compliance Officer, the Compliance Director, Human Capital Management or the Chief Executive Officer.
• Performs other duties as assigned.
  
  

Minimum Qualifications

• Degree in medicine, either M.D. or D.O. board certification and an unrestricted active NYS medical license required.
• 10 years of clinical practice experience required.
• Previous experience leading physicians, medical practices and/or managerial experience required.
• 5 years in senior medical leadership within a health plan, health system or population health organization preferred.
• Ability to understand and communicate a region & brand's unique value proposition to physicians, members, government, employer groups, and the larger communities we serve.
• Strong communication skills both oral and written.
• Deep expertise in healthcare quality, utilization management, clinical operations, and value-based care. Demonstrated ability to establish, develop, recommend, implement, and oversee utilization and quality policies requires.
• Demonstrated ability to lead physicians and influence cross functional teams in a matrixed environment.
• Excellent public speaking and relationship building skills; comfortable as the community facing clinical representative.
• Strong commitment to health equity and culturally responsive care.
• Demonstrated ability to serve as a patient and physician advocate for the Plan and the community.
• Ability to understand and communicate CDPHP’s unique value proposition to physicians, members, government, employer groups and the community in general.
  
  

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Compensation Range(s)

SL1: $304,800 - $450,000

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position’s minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.

Please note: There may be opportunities for remote work on all jobs posted by the LBS Recruitment team. This decision is made on a case-by-case basis.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.