Chief Medical Officer CHIP Health Plan (Pennsylvania)

Chief Medical Officer (CMO)

At CVS Health, we are building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels, and more than 300,000 purpose-driven colleagues caring for people where, when, and how they choose in a way that is uniquely more connected, more convenient, and more compassionate. And we do it all with heart, each and every day.

Position Summary :

The Chief Medical Officer (CMO) serves as the senior clinical leader for the Pennsylvania CHIP health plan, overseeing all medical management functions, quality initiatives, and clinical strategy. This role ensures the delivery of high-quality, cost-effective, and family-centered care to children and adolescents enrolled in the CHIP program. The CMO will lead efforts to improve health outcomes, ensure regulatory compliance, and foster innovation in pediatric care delivery.

Key Responsibilities :

• Develop and implement evidence-based clinical guidelines for pediatric care.
• Provide oversight for care management, utilization review, and case management programs.
• Serve as the final clinical authority on complex medical decisions, appeals, and grievances.
• Lead quality assurance programs, including HEDIS and CAHPS performance.
• Monitor and improve key pediatric health indicators (e.g., immunizations, well-child visits).
• Collaborate with internal teams to address health disparities and promote equity.
• Ensure full compliance with Pennsylvania DHS CHIP regulations and CMS standards.
• Oversee EPSDT smile (Early and Periodic Screening, Diagnostic, and Treatment) program implementation.
• Prepare for and participate in state audits, reviews, and corrective action planning.
• Support credentialing, training, and performance evaluation of pediatric providers.
• Promote clinical best practices and continuous improvement across the provider network.
• Resolve provider-related clinical issues and foster collaborative relationships.
• Contribute to organizational strategy, especially around pediatric population health.
• Lead initiatives in behavioral health integration, telehealth, and school-based services.
• Evaluate emerging trends and technologies to enhance care delivery.

Required Qualifications :

MD or DO degree with active Pennsylvania medical license (or eligibility).

Board certification in Pediatrics or a related specialty preferred.

Minimum 710 years of clinical experience, with at least 5 years in a managed care or health plan leadership role.

Deep understanding of CHIP, Medicaid, and pediatric health policy.

Strong leadership, communication, and stakeholder engagement skills.

Preferred Qualifications :

Experience with value-based care models and population health analytics.

Familiarity with HEDIS, NCQA accreditation, and EPSDT smile standards.

Passion for improving child health outcomes and reducing disparities.

Education :

MD or DO

Pay Range :

The typical pay range for this role is : $184,112.00 - $396,550.00. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography, and other relevant factors. This position is eligible for a CVS Health bonus, commission, or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program.

Our people fuel our future. Our teams reflect the customers, patients, members, and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people :

We take pride in our comprehensive and competitive mix of pay and benefits investing in the physical, emotional, and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include :

Affordable medical plan options , a 401(k) plan (including matching company contributions), and an employee stock purchase plan .

No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access, and many other benefits depending on eligibility.

We anticipate the application window for this opening will close on : 11 / 28 / 2025.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws.