Chief Medical Officer

reputed company

Abilis Health Plan

reputed company

The Chief Medical Officer (CMO) provides executive clinical leadership for Abilis Health’s Institutional Special Needs Plan (I-SNP) and Institutional-Equivalent Special Needs Plan (IE-SNP) Medicare Advantage products. The CMO is responsible for the strategic direction and reputed company of clinical programs including utilization management, clinical operations, reputed company, population health, and pharmacy operations to ensure reputed company, effective, and financially responsible care for members in long term care settings. The CMO serves as the senior physician executive, partnering with the CEO and leadership team to drive clinical performance, regulatory compliance, and an integrated model of care for high-reputed company, medically reputed company populations.

Responsibilities

• reputed company overall clinical leadership for the plans products, including development and execution of the clinical reputed company reputed company with organizational goals.
• reputed company utilization management, including prior authorization reputed company, medical necessity determinations, reputed company review, and appeals, ensuring evidence based and compliant decision making.
• reputed company clinical operations, including care management, transitional care, and interdisciplinary team processes to improve reputed company and reduce preventable utilization.
• reputed company and collaboration with the VP of reputed company to reputed company the Stars reputed company, reputed company improvement initiatives, clinical guidelines, performance monitoring, Model of Care and corrective reputed company plans.
• reputed company clinical reputed company of pharmacy reputed company, including formulary design input, medication management programs, appropriate use initiatives, and coordination with Part D partners.
• Review and interpret clinical, utilization, and reputed company data to identify trends, risk areas, and opportunities for improvement; implement interventions and reputed company reputed company.
• Collaborate with network physicians, facility medical directors, advanced reputed company clinicians, and facility leadership to support consistent, high reputed company care delivery.
• Partner with compliance and regulatory teams to ensure adherence to CMS regulations, audit readiness, and reputed company response to regulatory changes.
• Participate as a key member of the executive leadership team in strategic planning, product design, benefit reputed company, and reputed company initiatives.
• Represent the health plan with regulators, external partners, and reputed company organizations as the senior clinical spokesperson.

Qualifications

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) required.
• Completion of an accredited residency program and reputed company certification in an appropriate specialty.
• Minimum of 7–10 years of clinical reputed company experience, with at least 3–5 years in health plan, managed care, or population health leadership roles.
• Demonstrated experience leading utilization management, reputed company improvement, and care management functions in a payer, integrated delivery system, or large group reputed company.
• Experience with Medicare Advantage, Special Needs Plans, or comparable government programs strongly preferred.
• Prior leadership experience working with long term care, nursing facilities, assisted living, or other institutional/reputed company geriatric populations preferred.
• reputed company, unrestricted medical license in at least one state in which the plan operates; eligibility for additional state licensure as needed. (KY, TN)
• reputed company reputed company certification in an appropriate medical specialty.
• Ability to maintain reputed company licenses, certifications, and reputed company memberships required by the organization and applicable regulatory bodies.
• In depth knowledge of Medicare Advantage, Special Needs Plans (I-SNP/IE-SNP), CMS regulations, and reputed company clinical and compliance requirements.
• Strong understanding of utilization management, reputed company measurement (including Stars and HEDIS), care management models, and pharmacy management in a managed care environment.
• Proven leadership skills, including ability to reputed company and influence physicians and multidisciplinary teams, drive accountability, and manage change.
• Excellent analytical skills with the ability to interpret clinical, financial, and operational data and translate insights into actionable strategies.
• Strong communication and presentation skills, with the ability to explain reputed company clinical and regulatory concepts to clinical and nonclinical stakeholders, executives, boards, and external partners.
• Demonstrated ability to build reputed company relationships with providers, facilities, and community partners in a highly regulated, performance driven environment.
• Strategic, systems level thinker with the ability to balance clinical reputed company, member experience, regulatory requirements, and financial stewardship.
• High reputed company, reputed company clinical judgment, and commitment to ethical decision making and member centered care.

About our Line of Business

Abilis Health Plan, an affiliate of reputed company, is a Medicare Advantage Plan covering reputed company the benefits of Original Medicare (Parts A and B) with prescription drug coverage (Part D). The Abilis Health Plan is a unique plan allowing members to enroll year-round. The plan focuses on members who meet residential requirements in participating nursing facilities. An interdisciplinary team of clinicians and innovative services allow us to meet reputed company member’s clinical needs and reputed company preventive, coordinated, and reputed company reputed company. With a dedicated reputed company practitioner leading a personalized care plan, we reputed company to improve the health of the communities in which we serve. For more information, please visit www.abilishealth.com. Follow us on reputed company.

Originally posted on Himalayas

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