Chief Medical Officer

WPS Health Solutions • Madison, WI • 1d ago

JOB REQUIREMENTS: Description Role Snapshot As a key member of the
health plan\'s senior leadership team, the Chief Medical Officer (CMO)
partners with the Vice President of Health Services to oversee clinical
practices and medical management programs. The CMO ensures that members
receive high-quality, cost-effective care by applying clinical
expertise, evidence-based standards, and sound judgment. This leader
provides strategic direction, fosters provider and community
relationships, ensures compliance with regulatory requirements, and
drives continuous improvement in quality, affordability, and
member/provider satisfaction. Salary Range \$320,000 - \$360,000 The
base pay offered for this position may vary within the posted range
based on your job-related knowledge, skills, and experience. Hybrid Work
Location This position will be Hybrid, having the regional availability
to come into our Office on a regular cadence. Our office location: WPS
Corporate Center Building - 1717 W. Broadway in Madison, Wisconsin. How
do I know this opportunity is right for me? If you have experience with:
Clinical Oversight & Medical Leadership Provide medical oversight of
utilization management, medical necessity determinations, appeals, and
quality of care reviews. Develop and maintain medical policies,
procedures, and clinical practice guidelines that meet regulatory and
accreditation standards. Ensure clinical decisions align with
evidence-based medicine, quality standards, and member needs. Policy,
Quality & Compliance Oversee clinical quality improvement initiatives,
including URAC/NCQA/HEDIS adherence and certification. Chair and
participate in committees such as Medical Policy, Quality Improvement,
Credentialing, and Pharmacy & Therapeutics. Ensure compliance with CMS,
OCI, URAC, and other applicable regulations. Collaboration & Stakeholder
Engagement 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 medical
advisor on grievances, appeals, claims review, and new technology
evaluations. Build strong provider relationships to improve practice
patterns, utilization, and care outcomes. Strategic & Financial
Leadership Contribute to product and benefit design, growth initiatives,
and member/provider engagement strategies. Manage Health Services
budgets and use data-driven analysis to improve clinical outcomes and
cost-effectiveness. Representation & Communication Represent the health
plan in professional, regulatory, and community forums. Participate in
employer group meetings, RFP presentations, and provider communications.
Contribute CMO updates and thought leadership to internal and external
stakeholders. Team Leadership &... For full info follow application
link. Wisconsin Physicians Service Insurance Corporation is an Equal
Opportunity Employer/Protected Veterans/Individuals with Disabilities
employer. *** APPLICATION INSTRUCTIONS: Apply Online:
ipc.us/t/A1156FFFD7A2460B Qualified females, minorities, and special
disabled veterans and other veterans are encouraged to apply.

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