CMO-Health Plan Strategy, inVio Health Network
Inspire health. Serve with compassion. Be the difference.
Job Summary
The Chief Medical Officer (CMO) Health Plan Strategy of the inVio Health Network (CIN) is a pivotal executive leader responsible for shaping the clinical and strategic direction of the network. This role ensures the highest quality, patient-centered care while driving operational efficiency, cost-effectiveness, and provider alignment. The CMO will lead initiatives that enhance clinical integration, quality improvement, and value-based care models, fostering a high-performance healthcare network in collaboration with Prisma Health.
The CMO will also oversee the successful development, implementation, and measurement of quality improvement initiatives, health plan effectiveness, and care management strategies. This role is accountable for utilization review and management activities for health plans affiliated with Prisma Health/inVio Health Network.
Essential Functions
• All team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health. Serve with compassion. Be the difference.
• Clinical Leadership & Strategy
• Develop and implement clinical strategies to support the CIN’s mission, focusing on value-based care and population health management.
• Foster physician engagement and alignment with CIN goals, driving clinical integration and performance improvement.
• Collaborate with executive leadership to design and execute initiatives that enhance care coordination, patient outcomes, and cost efficiency.
• Drive financial performance through risk-adjusted reimbursement models and population health initiatives.
• Operational & Financial Oversight
• Partner with financial and operational leaders to align clinical initiatives with financial goals and payer contracting strategies.
• Oversee the implementation of care models that improve efficiency while maintaining high standards of care.
• Support contract negotiations with payers, ensuring alignment between clinical performance and financial incentives.
• Monitor and implement effective utilization review (UR) and utilization management (UM) functions within the Network.
• Physician & Provider Engagement
• Serve as a trusted liaison between physicians, network leadership, and payers to drive clinical and operational improvements.
• Participate actively in recruitment and orientation for new providers joining the network.
• Provide insight to incentive structures to align provider behavior with quality and financial performance targets.
• Develop and implement provider education programs on value-based care principles, offering mentorship and intervention strategies for underperforming providers.
• Value-Based Care & Population Health Management
• Guide the CIN’s transition from fee-for-service to value-based care, optimizing risk-based contracts and alternative payment models.
• Develop strategies for chronic disease management, preventive care, and care coordination to improve outcomes and reduce unnecessary utilization.
• Leverage data analytics to monitor performance metrics, risk stratification, and provider benchmarking. Serve as a key leader in the development, implementation, and adoption of the network’s provider scorecard.
• Implement initiatives to address social determinants of health and health equity.
• Quality & Performance Improvement
• Lead efforts to improve clinical quality, safety, and patient experience across the network.
• Oversee the development and implementation of evidence-based guidelines and best practices.
• Ensure compliance with regulatory and accreditation standards, including CMS, NCQA, and payer-specific requirements.
• Define and track key performance indicators (KPIs) such as HEDIS, STAR ratings, and provider engagement metrics.
• Performs other duties as assigned.
Supervisory/Management Responsibilities
• Job has direct and/or indirect supervision of team members that may include final budget authority, hire/termination authority, performance appraisal responsibility and disciplinary authority. Job will be considered a member of management staff at Prisma Health or affiliate and will have direct reports.
• The CMO will report directly to EVP Value-Based Care/CEO inVio Health Network and work closely with the Network executive leadership team. This role requires regular engagement with the inVio Health Network Board of Directors, local Governance Councils, and key stakeholders to align clinical and financial strategies.
• Responsible for hiring, performance management, and strategic oversight of teams involved in clinical quality, care management, and health plan relationships within the Network.
Minimum Requirements
• Education
• MD or DO with board certification in a relevant specialty.
• Advanced degree in healthcare management (MBA, MMM, MHA, CPE) preferred but not required based on experience.
• Experience
• Minimum of 5 years of experience in clinical leadership, population health, or value-based care, preferably within a CIN, ACO, integrated delivery system, or health plan.
• Strong knowledge of healthcare regulations, payer contracting, and alternative payment models.
• Proven ability to engage physicians, drive change, and optimize clinical and financial outcomes.
• Prior experience with payer relations and contracting preferred.
In Lieu Of
• NA
Required Certifications, Registrations, Licenses
• MD or DO with board certification in a relevant specialty.
Knowledge, Skills And Abilities
• Strategic vision for healthcare transformation and value-based care.
• Strong leadership and change management skills.
• Data-driven decision-making and analytical expertise.
• Effective communication and stakeholder engagement.
• Financial acumen related to healthcare reimbursement models.
Key Performance Indicators (KPIs)
• Improvements in network quality metrics (HEDIS, STAR ratings, patient satisfaction scores).
• Increased physician engagement and alignment with value-based care initiatives.
• Reduction in total cost of care and avoidable utilization.
• Financial performance tied to value-based agreements and payer contracts
Work Shift
Day (United States of America)
Location
Prisma Health Corporate Office
Facility
7002 Value-Based Care and Network Services
Department
70029035 Administrative and General
Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.
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