Medicare Advantage Plan CMO

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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Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.

About Clover: We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we’ve created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.

We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.

From Clover’s inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences and backgrounds, who share a passion for improving people’s lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. All of our employee’s points of view are key to our success, and inclusion is everyone’s responsibility.

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