Chief Medical Officer

Overview

This senior executive position is the Chief Medical Officer (CMO) of the Sendero Health Plans, Inc. The Chief Medical Officer (CMO) serves as the senior clinical leader for the HMO and other insured products as indicated, is responsible for oversight and strategic leadership of all Medical Management and Quality functions. Reporting directly to the CEO, the CMO will lead Utilization Management, Concurrent Review, Case Management, Social Work teams, Community Health Workers (CHWs), and the Quality Improvement Department.

This role ensures the delivery of high‑quality, cost‑effective care while maintaining compliance with state and federal regulations. The position collaborates closely with the System EVP & Chief Medical Officer to ensure health plan clinical strategies align with broader system‑level goals, while retaining responsibility for medical management specific to Sendero Health Plans’ unique regulatory and operational environment.

• Medical Management Leadership
  • Direct and oversee all Medical Management functions including Utilization Management, Concurrent Review, Case Management, Social Workers, and Community Health Workers.
  • Oversee the management of the pharmacy benefit program, including the implementation of programs to promote efficient use of HMO’s resources related to drug utilization.
  • Provide clinical leadership in the development and execution of care management strategies that support member health outcomes, cost containment, and regulatory compliance.
  • Develop and implement programs to increase the efficient delivery of quality care for low‑income and high‑risk populations.
  • Provides oversight of Pharmacy & Therapeutics Committee and/or other clinical committees as assigned.
  • Work in collaboration with the System EVP & Chief Medical Officer to ensure consistency and communication across the Enterprise.
• Quality Improvement Oversight
  • Lead the HMO’s Quality Improvement Department to design, implement, and monitor programs focused on clinical quality, patient safety, and regulatory performance measures (e.g., HEDIS, CAHPS, and NCQA).
  • Ensure continuous performance, improvement and achievement of quality benchmarks.
  • Provides leadership in the Quality Improvement (QI) reporting to the Board of Directors on Quality Improvement activities as mandated and implement CM/DM protocols, risk‑stratification, and policies based on evidence‑based medicine, best practices, and NCQA Accreditation standards.
  • Leads development for value‑based provider contracts and quality incentives for the health plan.
  • Ensure that network providers have been credentialed and re‑credentialed according to the Health Plan’s credentialing NCQA policies and procedures and collaborates with the System EVP & Chief Medical Officer to ensure consistency with system‑wide credentialing standards as relevant.
  • Manages a potential quality of care issue and facilitates the peer review process to take appropriate action, while coordinating with the System EVP & Chief Medical Officer on any systemic implications or shared providers, as indicated.
• Regulatory and Compliance Oversight
  • Ensure full compliance with the Texas Department of Insurance (TDI), Centers for Medicare & Medicaid Services (CMS), NCQA and all relevant accrediting and regulatory bodies.
  • Oversee and support the NCQA Accreditation for the Health Plan seeking to ensure accreditation at the highest standards.
  • Serve as a primary clinical contact during all audits and regulatory reviews.
• Clinical Policy Development
  • Lead the development and periodic review of Benefit Plans’ clinical guidelines, utilization criteria, and medical policies.
  • Guide clinical decision‑making processes that align with evidence‑based medicine and organizational goals.
• Cross Department Collaboration
  • Partner with departments including Provider Network, Pharmacy, Member Services, Operations, Finance, and Compliance to promote integrated strategies supporting health outcomes and member experience.
  • Serve as a clinical subject matter expert in executive leadership forums.
• Staff Leadership & Development
  • Directly manage the Sendero Medical Directors and provide leadership to clinical and non‑clinical…