Chief Medical Officer - Presbyterian Health Plan

Presbyterian Healthcare Services

  • Albuquerque, NM
  • $42.31 per hour
  • Permanent
  • Full-time
  • 19 days ago
Overview:Presbyterian Healthcare Services exists to improve the health of patients, members and the communities we serve. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees. Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.Presbyterian Health Plan (PHP) is seeking a visionary Chief Medical Officer (CMO) to drive transformative change. Reporting directly to the President of PHP, with a strategic dotted-line to the SVP/Chief Medical Officer of Presbyterian Healthcare Services (PHS), this role offers a unique opportunity to shape the future of care across New Mexico.As Health Plan CMO, you'll be the clinical architect behind PHP’s mission to deliver high-quality, cost-effective, and patient-centered care. You’ll lead annual strategic initiatives that elevate care quality and outcomes, optimize cost of care across populations, and enhance member and provider experiences.
  • Clinical Oversight: Provide expert guidance across all clinical domains, ensuring alignment with evolving standards of care and regulatory expectations.
  • Enterprise Collaboration: Engage with executive physician leaders, commercial account executives, and the PHP and PHS Boards to drive strategic alignment and innovation.
  • Thought Leadership: Represent PHP in high-impact forums, leading discussions that shape the organization’s clinical direction and influence broader healthcare policy.
Why New Mexico?🌄
  • Cultural Richness: From Santa Fe’s art scene to Albuquerque’s historic charm, New Mexico offers a vibrant cultural tapestry.
  • Outdoor Lifestyle: Enjoy 300+ days of sunshine with access to hiking, skiing, biking, and breathtaking landscapes.
  • Community Connection: Experience the warmth of diverse communities and a slower pace that supports work-life balance.
  • Affordable Living: Enjoy a lower cost of living compared to major metropolitan areas, with access to vibrant communities, rich cultural experiences, and stunning natural landscapes that support a balanced lifestyle.
Who You Are
  • A physician executive with deep experience in managed care, population health, and value-based strategies.
  • A strategic thinker who thrives in complex, matrixed environments and can translate clinical insights into business impact.
  • A collaborative leader who inspires cross-functional teams and builds trust with internal and external stakeholders.
Qualifications:
  • Medical degree (MD OR DO). Eligible for a New Mexico medical license.
  • Experience operating in a matrixed/collaborative environment.
  • A minimum of seven years of management experience in Managed Care.
  • 5 + years of utilization management experience and knowledge of quality accreditation standards
  • Minimum of 5 years of experience with Medicare Advantage.
  • Minimum of 5 years of experience with managed Medicaid.
Responsibilities:
  • The CMO is directly accountable for all clinical and pharmacy operations, strategies, and performance, including quality of care, care coordination, population health initiatives, medical cost management, prescription drug cost management, and strategic and business process improvement initiatives related to the same.
  • To facilitate collaboration and alignment across clinical and pharmacy, the VP of Pharmacy and Utilization Management will report to the CMO.
  • Collaborate with PHP Leadership Team on key initiatives, priorities, and strategic imperatives.
  • The CMO will direct PHP's Medical Directors and is accountable for the clinical components of utilization review, case management, health management, quality management, clinical process improvement, NCQA accreditation, pharmacy, behavioral health, employer-specific healthcare improvement initiatives, and provider-related services as assigned.
  • The CMO must be an advocate for the informed use of data and analytics through a strong partnership with PHS data and analytic teams
  • The CMO must collaborate with the VP of Sales and Marketing to provide input on embedded clinical and pharmacy benefits, and to report on and promote key clinical and pharmacy initiatives with key stakeholders.
  • The CMO must collaborate with the SVP of Integration to advance quality scores in Medicare Advantage Star program, Medicaid clinical and pharmacy measures, and Commercial quality and accreditation programs.
  • Develop new and innovative health-related activities to meet the PHP's mission and goals
  • Work closely with community clinicals and PDS system leadership to implement new programs, technologies and strategies that improve care delivery across the entire care continuum.
  • Recruit and retain a high-performing team that can achieve ambitious goals and champion ideas across the broader healthcare system.
  • As the senior medical management executive of PHP, the CMO will serve as the chief medical expert in the development of medical management policy and advising the PHP organization and external constituencies on health policy issues and representing Presbyterian Healthcare Services and PHP regarding medical affairs activities.
  • PHP has a healthy and successful relationship with the provider community. It will be the new CMO's responsibility to continue the company's legacy of relationships within the community. Essentially, the CMO will be the ambassador to the provider community and as such will serve as the critical interface between PHP and the provider/medical community and the government regulatory bodies concerned with the company's medical management functions.
  • This executive will be responsible for providing advice, direction and counseling, especially from a medical management standpoint to the President as well as to the principal operating heads of PHP and the Board of Directors. This will be to promote growth, development, accountability and profitability of every operation, and to maintain consistency in Presbyterian Health Plan. In addition, this individual will provide general business counseling, medical management strategic counseling for the President and act as a medical management/managed care arm and advisor in all potential strategic alliance issues, joint ventures, acquisitions and integrated health care partnerships.
Benefits:We offer more than the standard benefits!Presbyterian employees gain access to a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more!Learn more about our employee benefits:About New MexicoNew Mexico continues to grow steadily in population and features a low cost-of living. Varied landscapes bring filmmakers here from around the world to capture a slice of the natural beauty New Mexicans enjoy every day. Our landscapes are as diverse as our culture - from mountains, forests, canyons, and lakes, to caverns, hot springs and sand dunes.New Mexico offers endless recreational opportunities to explore and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses. Maximum Offer for this position is up to: USD $372.60/Hr. Compensation Disclaimer: The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.

Presbyterian Healthcare Services