Deputy CMO

Job Summary:

Responsible and accountable to the Chief Medical Officer for helping to manage medical health plan quality and costs and assuring appropriate health care delivery.  The Deputy Chief Medical Officer will focus on development of strategy, vision, policy, and procedures while operationalizing and improving the medical management team functions and outcomes.  The Deputy Chief Medical Officers’ overall purpose is to work across the medical management team focusing on improving operations in utilization management & case management while supporting team members in provider relations, pharmacy and accreditation and maintaining good relations with other departments who are dependent upon your services.  This is a broad function that includes day to day operations, data and reporting design and executing operational strategy, planning and policy development.   

Minimum Qualifications:

  • A MD degree from an accredited and approved school of medicine with a valid/ current license to practice medicine with Board Certification
  • A minimum of three years clinical experience
  • A minimum of three years’ experience in a managed care setting or insurance
  • Proven experience with heath informatics/data sciences
  • Integrity and trustworthy
  • Excellent written and oral communication with strong customer service focus 
  • Ability to solve problems and execute on initiatives
  • Ability to work collaboratively internally and externally
  • Ability to manage UM, CM and quality initiatives 
  • Demonstrate leadership skills, abilities and knowledge
  • Demonstrate management, and organizational and interpersonal skills.
  • Demonstrate ability to assess business needs, design, implement and execute operational plans while measuring and monitoring targets and evaluate results.

Job Duties and Responsibilities Include: 

  • Supervise and training of clinical positions;  
  • Supervise, manage, oversee and track UM and CM and Quality processes, projects and initiatives;
  • Examine work of staff and ensure conformance with policies and procedures;
  • Handle Protected Health Information (PHI) for duties related to provider credentialing, complaints and grievances, claims issues, and medical documentation.
  • Provide ongoing communication and documentation to employees regarding performance and development and conduct annual performance evaluations; conduct disciplinary actions and terminations, and resolve staff issues in a timely and professional manner;
  • Create and supervise department budgets
  • Reviews cases, determines medical necessity, review length of stay and reimbursement documentation;
  • Supports UM department staff on review and preauthorization referrals and ensures that members receive clinical services consistent with their benefits, regulatory requirements and established clinical criteria;
  • Provides clinical support for the appeals department;
  • Determine appropriate usage for health informatics data and assures decisions are made according to data insights;
  • Stays up to date with new technology assessment and clinical policy and procedure review as required;
  • Responsible for implementation of ongoing changes in policy and procedures from State and Government entities;
  • Participates in the development of strategic planning for existing and expanding business;
  • Represents the health plan at regulatory committee meetings as necessary;
  • Other duties as assigned by the Chief Medical Officer or President/CEO

Reporting to:  CMO


Please send your resume and completed application to CHP Human Resources at:

Mail: Consolidated Health Plans, Human Resources, 2077 Roosevelt Avenue, Springfield, MA 01104-3503

Fax: (413) 452-5329 Attn. Human Resources



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