Chief Medical Officer

JOB REQUIREMENTS: Description Role Snapshot As a key member of thehealth plan's senior leadership team, the Chief Medical Officer (CMO)partners with the Vice President of Health Services to oversee clinicalpractices and medical management programs. The CMO ensures that membersreceive high-quality, cost-effective care by applying clinicalexpertise, evidence-based standards, and sound judgment. This leaderprovides strategic direction, fosters provider and communityrelationships, ensures compliance with regulatory requirements, anddrives continuous improvement in quality, affordability, andmember/provider satisfaction. Salary Range $320,000 - $360,000 Thebase pay offered for this position may vary within the posted rangebased on your job-related knowledge, skills, and experience. Hybrid WorkLocation This position will be Hybrid, having the regional availabilityto come into our Office on a regular cadence. Our office location: WPSCorporate Center Building - 1717 W. Broadway in Madison, Wisconsin. Howdo I know this opportunity is right for me? If you have experience with:Clinical Oversight & Medical Leadership Provide medical oversight ofutilization management, medical necessity determinations, appeals, andquality of care reviews. Develop and maintain medical policies,procedures, and clinical practice guidelines that meet regulatory andaccreditation standards. Ensure clinical decisions align withevidence-based medicine, quality standards, and member needs. Policy,Quality & Compliance Oversee clinical quality improvement initiatives,including URAC/NCQA/HEDIS adherence and certification. Chair andparticipate in committees such as Medical Policy, Quality Improvement,Credentialing, and Pharmacy & Therapeutics. Ensure compliance with CMS,OCI, URAC, and other applicable regulations. Collaboration & StakeholderEngagement 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 medicaladvisor on grievances, appeals, claims review, and new technologyevaluations. Build strong provider relationships to improve practicepatterns, utilization, and care outcomes. Strategic & FinancialLeadership Contribute to product and benefit design, growth initiatives,and member/provider engagement strategies. Manage Health Servicesbudgets and use data-driven analysis to improve clinical outcomes andcost-effectiveness. Representation & Communication Represent the healthplan in professional, regulatory, and community forums. Participate inemployer group meetings, RFP presentations, and provider communications.Contribute CMO updates and thought leadership to internal and externalstakeholders. Team Leadership &... For full info follow applicationlink. Wisconsin Physicians Service Insurance Corporation is an EqualOpportunity Employer/Protected Veterans/Individuals with Disabilitiesemployer. APPLICATION INSTRUCTIONS: Apply Online:ipc.us/t/A1156FFFD7A2460B Qualified females, minorities, and specialdisabled veterans and other veterans are encouraged to apply.

Created: 2025-10-04