Chief Medical Officer

Location: This position may work remotely anywhere in the United States of America.  

We’re on a mission to make healthcare simpler and more effective. We fight to ensure our members get the care they need, when they need it, at the most affordable cost – that’s why we call ourselves Healthcare Warriors®. We’re committed to building diverse and inclusive teams, so if you’re excited about this position, we encourage you to apply – even if your experience doesn’t match every requirement.

The Chief Medical Officer (CMO) serves as a member of our executive team, providing overall clinical leadership in delivering safe, affordable, equitable care and high-quality member experience. The CMO focuses on developing and expanding our philosophy of care, engaging our clinical teams in shared core values, advancing our clinical service and product offerings, and leading clinical quality.

The CMO will actively work to enhance our clinical scale, grow our core healthcare navigation offering and guide our expansion into new markets. They will combine market insights/trends, clinical strategy and program development, and execution and outcomes delivery responsibilities. They will oversee and influence the development and delivery of our clinical identification and stratification model, high-cost case and physician engagement, clinical program management and client offerings. 

What you’ll do

• Provide strategic leadership for the innovation and monetization of clinical products and services that improve the health outcomes of our members and maximizes return on investment for our clients.
• Develop solid collaborative partnerships across a highly complex and matrixed organization including key partnerships with the leadership team, functional VPs, across all functional teams.
• Participate in executive strategy development and implementation to ensure that appropriate care and services provided to members meet best practice standards as well as regulatory compliance requirements and Internal Quality Assurance Program.
• Oversee clinical processes and policy decisions with a focus on implementing plans of care that meet accepted guidelines and protocols to ensure that optimal and appropriate medical and clinical services are provided.
• Ensure clinical services are delivered to members at the highest quality standards.  
• Serve as clinical subject matter expert for needs assessment, design, implementation, and evaluation of clinical programs to support continued growth and affordability.
• Lead in the development of clinical programs, including new care management programs to drive down trend and cost of care, potentially including partnering with the care delivery system (internal and external) on UM/CM best practices and shared operations.  
• Provide strategic leadership for core Medical Management and Rx Operations, UM/CM, member engagement, policy development / alignment / synchronization.  
• Interact with and effectively represent Quantum Health with prospective and current clients, clinical advisory boards and board of directors.
• Ensure compliance with clinical goals through monitoring care management performance.   
• Responsible for recommending changes and enhancements to current managed care, review guidelines, and clinical criteria based on extensive knowledge of health care delivery systems, utilization methods, reimbursement methods, and treatment protocols.  
• Develops, implements, and interprets medical policy including medical necessity criteria, clinical practice guidelines, new technology assessments and cost management.  
• Works directly with business unit leads to promote excellence in care and service delivery.  
• Be a visionary for our clinically oriented navigation model.
• Evangelize our care model with internal and external stakeholders.  
• Collaborate with internal experts in improving processes, systems and policies that improve patient care.  
• Help shape long-range planning and the development of scalable organizational goals, strategic plans, and objectives, including the development of new clinical services.  
• Lead discrete strategic initiatives that are prioritized on our roadmap.  
• Act as a subject matter expert for growth, strategy, and product efforts.  
• Provide clinical thought leadership, positioning Quantum Health as a national leader with clients, prospects and strategic partners.  
• All other duties as assigned.

What you’ll bring

• Education / Certification / Licensure: M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience; Master’s degree in Business Administration or relevant business experience.
• Experience: 10+ years of clinical leadership, building high-performance teams, in a for-profit, health outcomes-driven company; 5+ years of direct patient facing clinical work;
• Previous experience as a Chief Medical Officer or equivalent role in a national health plan or healthcare point solution focused on improving quality and cost outcomes.
• Demonstrated experience developing scalable, evidence-based clinical processes, care management protocols, health transformation efforts, and change management initiatives and directly implementing and evaluating them across care delivery contexts.
• Comprehensive knowledge of medical management principles and insurance products for multiple, varied lines of business in a managed care environment; Understanding of managed care systems, quality improvement and risk management.
• Demonstrated experience in seeing market trends, ideating and delivering clinical solutions that deliver both health outcomes and cost savings.
• Familiar with comparative payment and reimbursement models and able to develop creative financial methodologies that align incentives and drive improvement.  
• Ability to thrive in a high-growth, dynamic environment; excitemed by the challenge of building a business with ambitious goals.
• Mission-driven; highly collaborative with a high IQ/EQ mix and strong customer service orientation.  

What’s in it for you 

• Compensation: Competitive base pay and incentive plans. 
• Coverage: Health, vision and dental featuring our best-in-class healthcare navigation services, along with life insurance, legal and identity protection, adoption assistance, EAP, Teladoc services and more.  
• Retirement: 401(k) plan with up to 4% employer match and full vesting on day one. 
• Balance: Paid Time Off (PTO), 7 paid holidays, parental leave, volunteer days, paid sabbaticals, and more. 
• Development: Tuition reimbursement up to $5,250 annually, certification/continuing education reimbursement, discounted higher education partnerships, paid trainings and leadership development.  
• Culture: Recognition as a Best Place to Work for 15+ years, dedication to diversity, philanthropy and sustainability, and people-first values that drive every decision.   
• Environment: A modern workplace with a casual dress code, open floor plans, full-service dining, free snacks and drinks, complimentary 24/7 fitness center with group classes, outdoor walking paths, game room, notary and dry-cleaning services and more!  

What you should know 

• Internal Associates: Already a Healthcare Warrior? Apply internally through Jobvite. 
• Process: Application > Phone Screen > Online Assessment(s) > Interview(s) > Offer > Background Check 
• Diversity, Equity and Inclusion: Quantum Health welcomes everyone. We value our diverse team and suppliers, we’re committed to empowering our ERGs, and we’re proud to be an equal opportunity employer.  
• Tobacco-Free Campus: To further enable the health and wellbeing of our associates and community, Quantum Health maintains a tobacco-free environment. The use of all types of tobacco products is prohibited in all company facilities and on all company grounds. 
• Compensation Ranges: Compensation details published by job boards are estimates and not verified by Quantum Health. Details surrounding compensation will be disclosed throughout the interview process. Compensation offered is based on the candidate’s unique combination of experience and qualifications related to the position. 
• Agencies: Quantum Health does not accept unsolicited resumes or outreach from third-parties. Absent a signed MSA and request/approval from Talent Acquisition to submit candidates for a specific requisition, we will not approve payment to any third party.  
• Sponsorship: Applicants must be legally authorized to work in the United States on a permanent and ongoing future basis without requiring sponsorship. 

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