State Licensed Chief Medical Officer

Job Summary

A company is looking for a Chief Medical Officer.

Key Responsibilities

• Build trusted partnerships with client Medical Directors and senior payer stakeholders
• Shape payer-specific payment policies and provide clinical guidance during audits and appeals
• Collaborate with cross-functional teams to ensure clinically sound outputs and represent clinical perspectives in product innovation

Required Qualifications

• MD or DO with an active license
• 10+ years of experience in payment integrity, reimbursement operations, or claims auditing
• Strong knowledge of CMS, Medicare, Medicaid, and commercial payer adjudication rules
• Proven executive-level client engagement experience
• Demonstrated leadership with the ability to translate clinical insights into strategy