Chief Clinical Officer
Remote
Job Summary
Chief Clinical Officer (CCO) leads the clinical strategy for Medicare Advantage I-SNP/IE-SNP, aligning clinical vision with financial sustainability; oversees clinical programs, risk adjustment, quality, and care delivery models to improve health outcomes, ensure compliance, and balance high-quality care with sustainable costs. Responsibilities include guiding risk-adjustment strategy, collaborating with finance on revenue alignment, managing care management, utilization management, HRAs, provider and facility partnerships, CMS and NCQA quality programs (STAR, HEDIS, CAHPS), population health, and governance through chairing or participating in quality committees. Requires leadership of clinicians and staff (nurses, care managers, medical directors), and deep knowledge of CMS regulations, value-based care, affordability initiatives, and data-driven performance improvement.
Required Qualifications
- MD, DO, NP, or PA with active, unrestricted license; board certification preferred
- Minimum 10 years of clinical leadership experience, with at least 5 in managed care, Medicare Advantage, or long-term care
- Demonstrated expertise in I-SNP, Special Needs Plans, or institutional care models strongly preferred
- Strong knowledge of CMS Medicare Advantage regulations, risk adjustment (HCC coding, RAF scores), affordability strategies, and quality programs
- Proven ability to manage medical costs while improving member outcomes and satisfaction
- Data-driven leader with experience using analytics to drive clinical and financial performance
- Exceptional leadership, communication, and relationship-building skills
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