Role Overview for Chief Medical Officer (CMO) with a Health Plan – Philadelphia, PA
JRG Partners, a premier executive search firm, is proud to partner with a leading, mission-driven health plan in Philadelphia, PA, in their search for a transformative Chief Medical Officer (CMO). This is a pivotal executive leadership position for a dynamic physician executive passionate about shaping the future of healthcare delivery, improving member outcomes, and championing health equity within a diverse urban population. The CMO will serve as the senior clinical leader for the organization, reporting directly to the Chief Executive Officer (CEO) and playing a critical role on the executive leadership team.
As the CMO, you will be the clinical visionary, responsible for the overall direction, strategy, and oversight of all clinical functions. This includes Utilization Management, Care Management, Quality Improvement, Pharmacy, and Population Health initiatives. You will lead a dedicated team of clinical professionals, fostering a culture of innovation, collaboration, and clinical excellence.
Your leadership will directly influence the health and well-being of hundreds of thousands of members by ensuring the delivery of high-quality, cost-effective, and compassionate care. This role demands a unique blend of clinical expertise, business acumen, and strategic leadership. You will be instrumental in navigating the complex and evolving healthcare landscape, building strong relationships with our provider network, and ensuring compliance with all regulatory standards while driving the organization’s growth and success in the competitive Philadelphia market.
Key Responsibilities of Chief Medical Officer (CMO) with a Health Plan – Philadelphia, PA
Clinical Strategy and Leadership
Develop, implement, and oversee the organization’s clinical strategy in alignment with its mission, vision, and business objectives. Provide medical leadership and expertise across all departments, ensuring that clinical perspectives are integrated into all strategic decisions.
Quality Improvement and Management
Champion a culture of continuous quality improvement. Direct all activities related to NCQA accreditation, HEDIS reporting, and Medicare STAR ratings. Analyze performance data to identify opportunities and implement evidence-based interventions to improve clinical quality and member satisfaction.
Utilization and Care Management
Provide executive oversight for all Utilization Management (UM) and Care Management (CM) programs. Ensure programs are effective, efficient, and compliant, promoting appropriate levels of care, reducing unnecessary costs, and supporting members with complex health needs through innovative case and disease management strategies.
Provider Network Collaboration
Work closely with the network management team to foster strong, collaborative relationships with physicians, hospitals, and other healthcare providers. Provide clinical input on network development, credentialing processes, and value-based care arrangements.
Regulatory Compliance and Health Policy
Serve as the primary clinical liaison with regulatory bodies. Ensure the health plan maintains full compliance with all federal, state, and local healthcare regulations, including guidelines from the Centers for Medicare & Medicaid Services (CMS), the Pennsylvania Department of Health, and other relevant agencies. Stay abreast of emerging health policies and their potential impact on the organization.
Pharmacy Benefit Management
Oversee the clinical aspects of the pharmacy program, including formulary management, medication therapy management, and the relationship with the Pharmacy Benefit Manager (PBM). Drive strategies to promote safe, effective, and affordable medication use.
Population Health and Health Equity
Design and lead population health strategies to address the specific needs of the health plan’s diverse membership. Champion initiatives aimed at reducing health disparities, addressing social determinants of health, and promoting health equity across all communities served.
Data Analytics and Innovation
Leverage data analytics, clinical informatics, and predictive modeling to inform clinical strategy, measure program outcomes, and identify trends. Foster an environment of innovation, exploring and implementing new technologies and care models to enhance member care.
Financial Stewardship
Collaborate with the Chief Financial Officer (CFO) to manage the clinical budget effectively. Develop and implement strategies to manage medical costs while simultaneously improving the quality of care and member outcomes. Provide clinical insights for risk adjustment and medical cost forecasting.
Team Development and Mentorship
Lead, mentor, and develop a high-performing team of medical directors and clinical staff. Foster a collaborative, inclusive, and engaging work environment that attracts and retains top clinical talent.
Requirements for the Chief Medical Officer (CMO) with a Health Plan – Philadelphia, PA
Medical Degree
An M.D. or D.O. from an accredited medical school is required.
Licensure and Certification
Must possess an active, unrestricted license to practice medicine in the Commonwealth of Pennsylvania (or be eligible for licensure). Board Certification in a recognized medical specialty is mandatory.
Executive Experience
A minimum of 10 years of progressive leadership experience in a managed care setting, such as a health plan, an integrated delivery system, or a large provider group with significant risk-based contracting. At least 5 years of experience in a senior leadership role (e.g., VP, Senior Medical Director, or CMO) is strongly preferred.
Managed Care Expertise
Deep, hands-on experience with the core functions of a health plan, including quality improvement (HEDIS, STARS, NCQA), utilization management, care management, and provider network relations. Comprehensive knowledge of Medicare Advantage, Managed Medicaid, and Commercial insurance products is essential.
Advanced Education
A Master’s degree in Business Administration (MBA), Public Health (MPH), Health Administration (MHA), or a related field is highly desirable.
Strategic and Analytical Skills
Demonstrated ability to think strategically, analyze complex clinical and financial data, and develop innovative solutions to challenging problems. Proven success in driving measurable improvements in clinical and financial outcomes.
Leadership and Communication
Exceptional interpersonal, communication, and presentation skills. A proven ability to lead, influence, and build consensus among diverse stakeholders, including executives, clinical staff, providers, and regulators. A track record of building and mentoring high-performing teams.
Location
The candidate must be based in or willing to relocate to the greater Philadelphia, PA area. This is a visible leadership role that requires a significant presence in the local office and community.
Benefits & Perks Offered
Our client offers a highly competitive and comprehensive executive compensation and benefits package designed to attract and retain a top-tier leader. This includes:
Executive Compensation
A competitive base salary complemented by a significant annual bonus potential and a long-term incentive plan.
Comprehensive Health Coverage
Premier medical, dental, and vision insurance plans for you and your eligible dependents.
Retirement Savings
A robust 401(k) retirement plan with a generous company match and potential profit-sharing contributions.
Generous Time Off
A substantial paid time off (PTO) package, including vacation, sick leave, and paid holidays, to support a healthy work-life balance.
Executive Benefits
Includes executive-level life insurance, short-term and long-term disability coverage, and other ancillary benefits.
Relocation Assistance
A comprehensive relocation package is available for qualified candidates moving to the Philadelphia area.
Professional Development
A dedicated allowance for Continuing Medical Education (CME), professional association memberships, and executive leadership development opportunities.
Community Impact
The unique opportunity to make a lasting, positive impact on the health and well-being of the Philadelphia community.
How to Apply
JRG Partners is exclusively managing this confidential search. To be considered for this exceptional opportunity, please submit your curriculum vitae and a cover letter detailing your qualifications and interest in the role. All inquiries and applications will be handled with the utmost discretion and confidentiality.
JRG Partners is a leader in retained executive search for the healthcare industry. Our deep industry knowledge and extensive network allow us to connect visionary leaders with transformative opportunities. To learn more about our expertise and other executive-level positions, please visit the JRG Partners Healthcare Executive Search practice page.
Our client is an equal opportunity employer and is committed to creating a diverse and inclusive workplace. We encourage qualified candidates from all backgrounds to apply.
