Little Rock, Arkansas
Fort Wayne, Indiana
South Bend, Indiana
Hampton Roads/ Tidewater Region, Virginia
Raleigh, North Carolina
Posted: 17-Apr-25
Location: Sioux Falls , South Dakota
Type: Full Time
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Internal Number: R-0214043
Careers With Purpose
Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.
Department Details
Sanford Health’s executive leadership is based in Sioux Falls, South Dakota. A vibrant, strategically located city that reflects the values of our organization. Relocation to Sioux Falls is required for all C-suite roles, reinforcing our commitment to servant leadership and meaningful community engagement. As a premier rural health care organization, Sanford Health is dedicated to advancing innovation and excellence in partnership with the communities we serve.
Job Summary
The Chief Medical Officer is responsible for providing medical oversight, expertise and leadership to ensure the delivery of cost effective, quality healthcare services to health plan members. Reporting to the President and CEO of the health plan and collaborating with the senior leadership team within the plan and the system, the Chief Medical Officer will lead and directly manage the health plan’s key clinical teams and utilization review processes. Manages and leads Health Plan's medical directors, pharmacy team, and clinical operations team which includes utilization management, care management, population health, quality, risk adjustment and appeals and grievances.
Serves as clinical advisor to and educator of medical management staff making sure correct clinical judgment is applied to all medical management determinations. Provide leadership and expertise in the development, implementation and interpretation of medical review and quality related policies and guidelines.
Coordinate physician input and efforts to develop and coordinate clinical pathways, practice patterns, protocols and health insurance plans. Promote positive relations with the local medical community, including periodic consultation with providers or prescribers. Review case management data, identifies trends and gaps in care and recommends corrective actions. Review all quality of care issues and oversees the development and implementation of processes for improvement.
Participate in and provide clinical expertise in data collection and analysis to achieve high-quality services and cost efficiency. Monitor performance indicators to ensure the delivery of cost-effective care within quality standards. Applies advanced technical knowledge of clinical medicine and the medical insurance industry to solve highly complex challenges.
Ensure the delivery of safe, high-quality health care in accordance with enterprise mission, vision and strategic goals.
Qualifications
Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) required. Master's degree in business administration, population health, public health, or health care economics preferred.
Minimum of three years of health plan/insurance experience preferred. Rural experience preferred.
Must be licensed (or obtain license) to practice medicine in South Dakota or Wisconsin.