Chief Medical Officer

Description

Role Snapshot

As a key member of the health plan’s senior leadership team, the Chief Medical Officer (CMO) partners with the Vice President of Health Services to oversee clinical practices and medical management programs. The CMO ensures that members receive high-quality, cost-effective care by applying clinical expertise, evidence-based standards, and sound judgment. This leader provides strategic direction, fosters provider and community relationships, ensures compliance with regulatory requirements, and drives continuous improvement in quality, affordability, and member / provider satisfaction.

Salary Range

$320,000 - $360,000

The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience.

Hybrid Work Location

This position will be Hybrid, having the regional availability to come into our Office on a regular cadence. Our office location : WPS Corporate Center Building - 1717 W. Broadway in Madison, Wisconsin.

How do I know this opportunity is right for me? If you have experience with :

Clinical Oversight & Medical Leadership

Provide medical oversight of utilization management, medical necessity determinations, appeals, and quality of care reviews.

Develop and maintain medical policies, procedures, and clinical practice guidelines that meet regulatory and accreditation standards.

Ensure clinical decisions align with evidence-based medicine, quality standards, and member needs.

Policy, Quality & Compliance

Oversee clinical quality improvement initiatives, including URAC / NCQA / HEDIS adherence and certification.

Chair and participate in committees such as Medical Policy, Quality Improvement, Credentialing, and Pharmacy & Therapeutics.

Ensure compliance with CMS, OCI, URAC, and other applicable regulations.

Collaboration & Stakeholder Engagement

Partner with internal teams (including Network, Product, Marketing, Operations, Actuarial) and external partners (including PBMs, TPAs, providers) to achieve health plan goals.

Serve as a medical advisor on grievances, appeals, claims review, and new technology evaluations.

Build strong provider relationships to improve practice patterns, utilization, and care outcomes.

Strategic & Financial Leadership

Contribute to product and benefit design, growth initiatives, and member / provider engagement strategies.

Manage Health Services budgets and use data-driven analysis to improve clinical outcomes and cost-effectiveness.

Representation & Communication

Represent the health plan in professional, regulatory, and community forums.

Participate in employer group meetings, RFP presentations, and provider communications.

Contribute CMO updates and thought leadership to internal and external stakeholders.

Team Leadership & Development

Lead, mentor, and develop clinical staff to foster a culture of accountability, excellence, and engagement.

Support training to ensure consistent application of policies, guidelines, and regulatory requirements.

Minimum Qualifications

Medical Degree (MD or DO) from an accredited institution.

Board-certified in an American Board of Medical Specialties recognized specialty.

Current Medical license in Wisconsin without restrictions to practice, and free of sanctions from working in federal programs.

10 or more years of health plan work experience.

5 or more years of progressive leadership experience overseeing health plan medical management programs, including utilization management, case management and quality improvement.

5 years or more of experience working in a medical practice, including working within a hospital or clinic.

Strong clinical knowledge with an understanding of health insurance policies, medical and utilization management, risk management, risk adjustment, disease management, quality improvement, evidence-based guidelines, pharmacy benefit management, and regulatory requirements.

Excellent leadership, organizational, communication and consensus building skills.

Strong knowledge of commercial and government products / programs and their related customer segments.

Experience with URAC / NCQA accreditation and HEDIS measures.

Strong business and financial acumen, and analytical and problem-solving skills with an emphasis on using data to drive decision making.

Entrepreneurial mindset; able to think strategically and operate tactically.

Ability to identify, prioritize and drive work efforts with the highest returns on investment to achieve desired health plan goals.

In depth knowledge and understanding of applicable state, federal and third-party regulations and requirements.

Able to work in a complex, rapidly evolving environment with multiple internal and external stakeholders.

Working knowledge of the challenges facing health plans and the broader healthcare industry.

Expertise in Microsoft Office, medical systems, software and technology, Milliman Care Guidelines, Hayes, Aerial, and InterQual.

Excellent communication and presentation skills; comfortable engaging with employer groups and demonstrating the value of our medical management services and products.

Preferred Qualifications

Master’s degree in Business Administration, Healthcare Administration, Public Health, or a relevant area of focus.

Experience with Medicare Supplement, ASO / self-funded, and level-funded products.

Deep understanding of the Wisconsin healthcare market, including health systems and payors.

Remote Work Requirements

High speed cable or fiber internet

Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at )

Please review Remote Worker FAQs () for additional information

Benefits

Remote and hybrid work options available

Performance bonus and / or merit increase opportunities

401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately)

Competitive paid time off

Health insurance, dental insurance, and telehealth services start DAY 1

Professional and Leadership Development Programs

Review additional benefits : ( )

Who We Are

WPS Health Solutions () is a leading not-for-profit health insurer and federal government contractor headquartered in Wisconsin. WPS offers health insurance plans for individuals, families, seniors, and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS Health Solutions has been making health care easier for the people we serve for more than 80 years () . Proud to be military and veteran ready.

Culture Drives Our Success

WPS’ Culture is where the great work and innovations of our people are seen, fueled, and rewarded. We accomplish this by creating an open and empowering employee experience. We recognize the benefits of employee engagement as an investment in our workforce—both current and future—to effectively seek, leverage, and include differing and unique perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities.

We are proud of the recognition we have received from local and national organization regarding our culture and workplace : WPS Newsroom - Awards and Recognition. ()

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Equal Opportunity Employer / Protected Veterans / Individuals with Disabilities

This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights () notice from the Department of Labor.