Position Summary: The Chief Medical Officer, Clinical Performance & Operations serves as the senior physician executive responsible for physicians' clinical performance, efficiency, utilization management strategy, and care management oversight across the organization. Reporting to the Chief Medical Affairs Officer, this role provides physician leadership to ensure the delivery of high-quality, cost-effective, member-centered care while advancing organizational goals related to clinical outcomes, utilization, and total cost of care.

Working in close partnership with the Senior Vice President of Clinical Operations, the Chief Medical Officer, Clinical Performance & Operations establishes the clinical strategy, performance goals, and operational priorities necessary to optimize population health, improve member outcomes, and achieve sustainable financial performance. Together, they serve as a dyad leadership team responsible for defining, monitoring, and achieving key clinical and operational objectives.

The role provides physician oversight of Utilization Management and Care Management functions, ensuring that clinical decision-making, care coordination, and population health interventions are aligned with organizational priorities and the principles of the Triple Aim: improving member experience, improving population health, and reducing the per-capita cost of care.

Essential Position Functions/Responsibilities:
Clinical Performance Leadership

• Provide executive physician leadership for Utilization Management and Care Management programs across the organization.
• Establish and monitor clinical performance goals designed to improve health outcomes while managing medical expense and resource utilization.
• Guide population health performance through evidence-based clinical interventions and operational excellence.
• Ensure alignment between clinical programs, organizational objectives, regulatory requirements, and member needs.

Utilization Management Oversight

• Provide physician oversight and strategic direction for Utilization Management activities, including prior authorization, medical necessity determinations, appeals, and clinical policy development.
• Ensure utilization management programs promote the delivery of the right care, at the right time, in the right setting.
• Monitor and improve utilization performance through analysis of trends, variation, and opportunities for intervention.
• Partner with Medical Directors and operational leaders to drive consistency, compliance, efficiency, and clinical excellence.

Care Management and Population Health

• Provide physician oversight of Care Management programs to ensure effective management of high-risk, rising-risk, and complex populations. Examples include: Participating in clinical rounds, oversight of scripting clinical policy,
• Partner with clinical operations leadership to ensure care management programs improve outcomes, reduce avoidable utilization, and enhance member experience.
• Promote integration across Utilization Management, Care Management, Quality, and Population Health functions.
• Ensure members remain at the center of all clinical and operational decision-making.

Performance Management and Analytics

• Establish and oversee key clinical performance indicators and population health metrics.
• Monitor and analyze performance related to:
• Admissions per 1,000 (ADK)
• Emergency Department visits per 1,000 (EDK)
• Readmission rates
• Bed days per 1,000
• Avoidable utilization
• Care management engagement and outcomes
• Total cost of care
• Clinical quality and population health measures
• Utilize data and analytics to identify opportunities, prioritize interventions, and measure organizational impact.
• Drive accountability for performance improvement initiatives across clinical teams.

Clinical Operations Partnership

• Serve in a dyad leadership model with the Senior Vice President of Clinical Operations.
• Collaboratively define annual goals, strategic priorities, and operational performance expectations.
• Support the development and implementation of innovative programs designed to improve quality, efficiency, and member outcomes.
• Provide physician leadership for clinical transformation initiatives and operational redesign efforts.

Executive Leadership and Communication

• Present clinical performance, utilization trends, population health outcomes, and strategic recommendations to executive leadership, boards, and other stakeholders.
• Translate complex clinical and operational data into actionable business insights.
• Prepare and deliver executive-level presentations regarding organizational performance, opportunities, risks, and recommended actions.
• Represent the organization in discussions with providers, regulators, partners, and external stakeholders as appropriate.

Medical Affairs Leadership

• Provide physician consultation and leadership across the organization on matters related to utilization management, care management, population health, and clinical operations.
• Collaborate closely with Quality, Risk Adjustment, Network Strategy, Finance, and Analytics leaders to support enterprise goals.
• Participate in strategic planning and organizational performance reviews.
• Perform additional duties and special projects as assigned by the Chief Medical Affairs Officer.

Qualifications

• MD or DO with current unrestricted medical license.
• Board certification in an ABMS or AOA-recognized specialty.
• Minimum of 10 years of progressive physician leadership experience within managed care, health plans, IPA/MSO organizations, ACOs, or integrated delivery systems.
• Demonstrated expertise in Utilization Management, Care Management, Population Health, Medical Expense Management, and Clinical Operations.
• Strong understanding of healthcare economics, total cost of care, and value-based care models.
• Exceptional analytical, communication, and presentation skills with demonstrated ability to influence executive leadership and operational teams.
• Proven ability to lead through collaboration and drive measurable improvements in clinical and financial performance.

Qualification Requirements:
Skills, Knowledge, Abilities

• Must possess excellent communications skills to interface with providers, staff, and management.
• Knowledge of medical, quality improvement and UM practices in a managed care environment.
• Knowledge of regulatory and accreditation agencies and requirements
• Able to manage multiple priorities and deadlines in an expedient and decisive manner.
• Able to manage difficult peer situations arising from medical care review.
• Appreciation of cultural diversity and sensitivity towards target population.
• Up-to-date knowledge of new information and technologies in medicine, and their application to appropriate clinical management approaches, as well as computer applications, including productivity tools and Care Management Platforms.
• Must be available during normal working hours to make coverage decisions. Additional after-hours availability may be required to review emergently or urgently needed services.

Training/Education:

• MD or DO Degree
• Board Certification required in Internal Medicine
• Unrestricted NY State License to Practice Medicine
• No current or past sanctions by any federal or state regulatory body

Experience:

• Minimum of 5 years of clinical experience should include direct care experience in both inpatient and outpatient services
• 10 years of clinical experience in the practice of medicine
• 10 years of experience in medical and/or health administration in a managed care setting is preferred.
• 10 or more years of management and/or clinical experience in a managed care environment are preferred.

Working Conditions:
100% office based work environment unless otherwise assigned by the CMAO or CEO

Our website: HealthCare Partners
Base Compensation: $350,000.00-$425,000.00 annually
Bonus Incentive: Eligibility based off organizational performance
Benefits: Fully paid Medical & Dental employee coverage + robust benefits package (PTO, 401k, FSA, Tuition Reimbursement, etc.)

Job Disclaimer:
The above job description outlines the general scope and responsibilities of the position. It is not intended to be an exhaustive list of duties, skills, or qualifications required. Responsibilities may evolve based on business needs.
Department: Administration This is a management position This is a full time position