Chief Medical Officer (CMO)

Overview

Chief Medical Officer (CMO) role at Rocky Mountain Health Care Services (RMHCS). The CMO provides strategic and operational medical leadership to ensure the highest standards of clinical quality, participant safety, and regulatory compliance. The CMO reports to the President and oversees medical policy, decision-making, and all medical affairs and clinical functions, including participant care, utilization management, quality assurance, and credentialing. The CMO fosters collaboration among providers, oversees clinical quality improvement initiatives, and represents the organization with regulators, community stakeholders, and the Board of Directors.

Mission : Improving lives, Optimizing wellness, Promoting independence

Responsibilities

• Provides overall leadership and oversight of RMHCS physicians and nurse practitioners, including hiring, supervision, evaluation, training, and education.
• Champions a culture that prioritizes provider well-being, resilience, and engagement, recognizing their essential role in delivering safe, high-quality participant care.
• Evaluates and improves medical service delivery, embraces best practices, and leads development of standards of care for RMHCS.
• Responsible for the delivery of participant care and clinical outcomes.
• Reviews pharmacy utilization, pharmacy reports, and processes.
• Leads the RMHCS utilization management program, including establishing evidence-based clinical criteria for diagnostic testing, referrals, procedures, hospital admissions, and post-acute care services.
• Leads review processes for high-cost / high-frequency or complex cases, monitors utilization trends, and identifies patterns of overuse or underuse.
• Works with interdisciplinary teams to align care delivery with clinical best practices, reduce unnecessary variation, and improve participant outcomes.
• Collaborates with RMHCS Executive Team to enhance organizational development, service delivery, and strategic initiatives.
• Ensures regulatory compliance, engages providers in peer-to-peer case discussions, and implements corrective action plans when utilization concerns are identified.
• Oversees the orientation / onboarding of new providers to PACE standards and regulations.
• Provides direct participant care as needed.

Credentialing & Quality Management

Network Development & Relationship Building

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