Chief Medical Officer, Essence Healthcare

Your Future is our Future At Lumeris, we believe that our greatest achievements are made possible by the talent and commitment of our team members. That's why we are actively seeking talented and collaborative individuals who are passionate about making a difference in the healthcare industry. Join us today as we strive to create a system of care that every doctor wants for their own family and become part of a community that values its people and empowers you to make an impact. We're excited to consider every qualified candidate authorized to work in the United States, although we are unable to sponsor visas for this role at this time. Position: Chief Medical Officer, Essence Healthcare Position Summary: Provides strategic direction and clinical expertise to guide policy, programs, and overall healthcare delivery. Serving as the top clinical executive for Essence Healthcare, this role ensures the delivery of high-quality, cost-effective, and patient-centered care by driving provider performance, leading Pharmacy strategy, maximizing CMS Star Ratings, and guiding clinical operations. The CMO maintains ultimate clinical accountability for health plan performance, ensuring that clinical initiatives directly support the organization's value-based care model, membership growth, and medical cost containment. The next CMO will play a critical role in helping Essence navigate its next phase of growth by strengthening operational performance, improving Stars and quality outcomes, enhancing clinical affordability, and scaling clinical capabilities to support expansion into new markets. Job Description Primary Responsibilities Leadership & Executive Oversight Oversees, coaches, mentors, motivates, supports, and develops a cross-functional team of seasoned people leaders with a broad scope. Ultimately responsible for medical cost management, quality, and the clinical efficacy of Essence Healthcare programs. Contributes to the Clinical thought leadership of Essence through presentations, case studies and scientific articles. Stars & Quality Strategy Serves as the executive leader & sponsor for all CMS Star Rating initiatives, overseeing the Stars team and partnering cross-functionally across Clinical, Operations, Technology, and Marketing to achieve and maintain top-tier (4.5+) quality scores. Directly oversees the VP, Quality & Stars Strategy to align HEDIS, CAHPS, and Health Equity strategies with the plan's overall clinical and operating model. Directs and monitors Quality management programs as needed to maintain compliance with CMS, NCQA, and other accrediting bodies. Provider Performance & Population Health Management Oversees Population Health Management programs and initiatives to ensure value-based objectives with primary care physicians, medical groups, and health systems are achieved. Fosters strong relationships with Essence physicians and partners with medical groups on provider performance management. Serves as a key clinical voice in strategic provider joint quality committees, driving performance on clinical outcomes, preventative care gaps, and risk adjustment accuracy. Participates in the alignment of physician incentives, quality measures, and value-based contracts. Collaborates with network strategy leaders to design and implement clinical incentive models that promote provider engagement and align with value-based contracting targets. Plans and facilitates medical director meetings to ensure thought leadership through effective communication and collaboration. Pharmacy Strategy & Economics Drives the overarching strategy for Pharmacy economics, clinical outcomes, and Part D performance in partnership with VP of Pharmacy. Coordinates health plan pharmacy management initiatives to ensure clinical and cost optimization. Clinical Operations Oversees and coordinates the strategic direction of the health plan's Utilization Management & Care Management (CM) programs, ensuring high-quality, coordinated care for high-risk members and clinical optimization of population health workflows. Partners with operating and technology teams to evaluate and scale clinical programs & initiatives that support provider engagement and align with value-based care objectives. Qualifications MD. or D.O. degree, plus Board Certification Current, unrestricted medical license 15+ years of relevant experience or the knowledge, skills, and abilities to succeed in the role 7+ years of people, program, or project leadership experience or the knowledge, skills, and abilities to succeed in the role Demonstrated experience in a successful clinical practice Substantial Medicare Advantage experience Proven health system, health plan or capitated provider experience with exposure to managing total cost of care, quality, and documentation and coding Deep understanding of population health & managed care Strong background in administrative clinical leadership Solid understanding and experience with population health management strategies Knowledge of healthcare financing and the relation to various managed care products (HMO, PPO, Indemnity, and Medicare Advantage) Knowledge of continuous quality improvement theory and practice, specifically relating to CMS Star Ratings. Excellent communication and problem-solving skills Demonstrated track record of developing productive working relationships internally and externally at all levels Expert ability to positively impact results Deep, specific knowledge of Medicare Advantage Stars domains, including Part C (HEDIS, CAHPS, HOS) and Part D clinical pharmacy metrics. Demonstrated experience overseeing Care Management & Utilization Management programs and clinical population health strategies within a Medicare Advantage plan. Demonstrated experience leading health equity initiatives, clinical quality improvement programs, and compliance with CMS clinical regulations. Ability to travel up to 50% as required for in-person executive leadership meetings, strategic provider partnerships, and regional clinical engagement/provider performance reviews. Pay Transparency Factors that may be used to determine your actual pay rate include your specific skills, experience, qualifications, location, and comparison to the other employees already in this role. In addition to the base salary, certain roles may qualify for a performance-based incentive and/or equity, with eligibility depending on the position. These rewards are based on a combination of company performance and individual achievements. The hiring range for this position is: $238,300.00-$350,575.00 Benefits of working at Lumeris Medical, Vision and Dental Plans Tax-Advantage Savings Accounts (FSA & HSA) Life Insurance and Disability Insurance Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days) Employee Assistance Program 401k with company match Employee Resource Groups Employee Discount Program Learning and Development Opportunities And much more... Member Facing Position: No- Not Member or Patient Facing Position Drug Screen Requirement: No MVR Required: No Credit Check Required: No Location: Remote, USA Time Type: Full time Lumeris and its partners are committed to protecting our high-risk members & prospects when conducting business in-person. All personnel who interact with at-risk members or prospects are required to have completed, at a minimum, the initial series of an approved COVID-19 vaccine. If this role has been identified as member-facing, proof of vaccination will be required as a condition of employment. Disclaimer: The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individual with disabilities to perform the essential job duties and responsibilities. Lumeris is an EEO/AA employer M/F/V/D. Join Our Growing Team! Lumeris is bringing common sense back to the business of healthcare by empowering value-based care. We create the partnerships and perspectives that are making healthcare safer, more affordable and more personalized for providers, patients and payers alike. We were founded on the belief that it should be easier to provide the right care, at the right time, at the right cost. Our model is bringing that belief to life, improving outcomes and empowering financial sustainability along the way. Why Join Lumeris? At Lumeris, you will be part of team that is focused on solving the nation’s healthcare problem, and you will be able to contribute to our purpose. Our environment is fast-paced, change-oriented and focused on growth and employee engagement. At Lumeris, we know that talent is best utilized when given the opportunity to succeed. That is why we have removed the boundaries that inhibit success and focus on fostering an environment that allows employees to utilize their talents. #J-18808-Ljbffr Lumeris Inc.