Job Posting Title

Agency

Supervisory Organization

Job Posting End Date

Refer to the date listed at the top of this posting if available. Continuous if date is blank.

Note: Applications will be accepted until 11:59 PM on the day prior to the posting end date above.

Estimated Appointment End Date (Continuous if Blank)

Full/Part-Time

Job Type

Compensation

Why Youll Love Working Here

At the Oklahoma Health Care Authority (OHCA) your work matters. Every day our team helps ensure Oklahomans have access to better health and better care. Guided by our core values Passion for Purpose Trust & Transparency Empowerment & Accountability Best-in-Class Outcome-Driven and Servant Leadership we foster a workplace where people feel supported respected and empowered to make an impact. Learn more about OHCA.

Lets Talk Benefits

We know your great work deserves great support. Heres a snapshot of what we offer for all eligible employees.

• Generous state-paid benefit allowance to offset insurance premiums.

• A wide selection of insurance plans with no pre-existing condition exclusions.

• Flexible Spending Accounts for health care and dependent care.

• Retirement Savings Plan with employer contributions.

• 11 paid holidays annually.

• 15 days of vacation and 15 days of sick leave in the first year.

• Longevity Bonus recognizing years of public service.

• Public Service Loan Forgiveness eligibility and tuition reimbursement.

• Wellness benefits including an on-site gym and fitness center discounts.

Job Description

Agency/Division Information

The Oklahoma Health Care Authority (OHCA) works to ensure Oklahomans have access to better health and better care. The agencys core values include passion for purpose trust and transparency empowerment and accountability best in class and outcome-driven and servant leadership. As part of the interview process candidates may be required to attend an in-person interview at our Oklahoma City office.

Position Purpose

The Chief Medical Officer (CMO) serves as the senior clinical leader responsible for the oversight direction and continuous improvement of the agencys medical functions across the Medicaid program and the HealthChoice / Employees Group Insurance Division (EGID). As a licensed Medical Doctor (MD) or Doctor of Osteopathy (DO) the CMO provides strategic clinical leadership and medical expertise to ensure the quality effectiveness accountability and regulatory compliance of medical services. Working in close coordination with executive leadership the CMO directs medical policy development clinical guidelines and operational strategies to advance health care delivery program innovation and system integrity. This role ensures that covered services and medical practices align with accepted standards of care statutory and regulatory requirements agency goals and fiscal stewardship while optimizing health outcomes for members and supporting sustainable cost-effective programs.

Principal Activities May Include:

• Medical Oversight and Clinical Guidance: Provide expert medical review and executive-level clinical leadership for utilization management case management medical necessity determinations appeals quality improvement program integrity and policy development activities. Ensure all medical determinations meet accepted standards of care evidence-based guidelines and applicable federal and state requirements.

• Strategic Planning and Operational Leadership: Lead the development and execution of divisional goals; adjust operational strategies to enhance program performance; supervise professional staff; and systematically evaluate division operations to implement improvements in efficiency effectiveness and fiscal accountability.

• Policy Interpretation Development and Regulatory Alignment: Interpret federal and state legislation and regulations affecting medical behavioral health dental and pharmacy policy. Provide regular clinical and strategic input on the potential impact of policy and operational decisions on health care delivery. Advise internal leadership and collaborate with OMES/EGID actuaries and other partners to assess statutory and regulatory impacts on benefits and programs.

• Medical Management and Systems Oversight: Oversee medical management activities including utilization review determinations of medical necessity coverage decisions exceptions to network care and review of novel or emerging treatment requests. Provide clinical direction and oversight for Medicaid Management Information System (MMIS) claims editing and fraud waste and abuse detection systems to ensure consistent application of medical policy.

• Quality and Performance Management: Administer performance standards with measurable criteria to ensure compliance with laws policies and clinical best practices. Oversee quality assurance performance improvement initiatives External Quality Review Organization (EQRO) activities and quality oversight committees. Establish benchmarks to promote continuous improvement and excellence in service delivery.

• Leadership Supervision and Knowledge Transfer: Lead mentor and supervise Medical and Dental Directors consultants and clinical and administrative staff. Identify training needs support professional development and foster a culture of continuous learning and accountability to maintain current medical knowledge and elevate team performance.

• Stakeholder Engagement and Representation: Partner with internal and external stakeholders to align programs with state and federal requirements support quality improvement and advance innovation. Represent the agency at state and national meetings task forces legislative activities and collaborative partnerships to promote evidence-based care and strengthen agency outcomes.

• Clinical Authority and Licensure: Exercise independent clinical judgment in medical determinations appeals and coverage decisions. Maintain a current Oklahoma MD or DO license as required to fulfill assigned responsibilities

• Other duties as assigned.

Supervisory Responsibilities: This position supervises.

Knowledge Skills Abilities and Competency Requirements

**To be considered for this position your application must include a resume/CV with complete work and education history.**

The Chief Medical Officer (CMO) serves as the senior clinical leader responsible for the oversight direction and continuous improvement of the agencys medical functions across the Medicaid program and the HealthChoice / Employees Group Insurance Division (EGID). As a licensed Medical Doctor (MD) or Doctor of Osteopathy (DO) the CMO provides strategic clinical leadership and medical expertise to ensure the quality effectiveness accountability and regulatory compliance of medical services. Working in close coordination with executive leadership the CMO directs medical policy development clinical guidelines and operational strategies to advance health care delivery program innovation and system integrity. This role ensures that covered services and medical practices align with accepted standards of care statutory and regulatory requirements agency goals and fiscal stewardship while optimizing health outcomes for members and supporting sustainable cost-effective programs.

Education and/or Experience:

• A bachelors degree in public health or health related degree business administration or a closely related field AND

• Current license to practice medicine as a Medical Doctor (MD) or Doctor of Osteopathy (DO) in the state of Oklahoma and recognized by national regulatory bodies in the US AND

• Minimum of 5-10 years of postgraduate experience in direct patient care with progressively more responsibility in a health care setting AND

• Be board certified by an appropriate specialty college or program (or DO equivalent) AND

• Three (3) years of medical management or supervisory experience as a medical professional. AND

• Current active state license with DEA privileges; if not fully licensed in OK must complete licensing in OK within 6 months of hire AND

• Must remain up to date with annual continuing education requirements

Preference Qualifications Include:

• ABMS Board Certification

• MD/DO License with at least 10 years experience

• Advanced management degree (MBA MPH MPM or related degree)

• Working knowledge of CPT/HCPCS coding

• Work experience as a Medical Director

• Supervisory and leadership experience

• Capable of effectively communicating and motivating associates at all levels of the organization including executive staff

• Experience in implementing utilization and quality improvement strategies/techniques and experience with physician behavior modification

• Experience in developing medical policy procedures and programs

• Excellent public/physician relations

Physical Demands

• Must be able to remain sitting for prolonged periods at a desk and working on a computer.

• Must be able to move or lift up to 15 pounds at various times.

Work Environment

The office work environment includes regular exposure to general office equipment such as computer equipment phones and copy machines.

Why Youll Love Working Here

At the Oklahoma Health Care Authority (OHCA) were proud to create a workplace where employees thrive. Named a Top Workplace in Oklahoma for five consecutive years this achievement reflects the dedication and collaborative spirit of our incredible team. Heres what we offer to support employees and their family:

• Generous state-paid benefit allowance to offset insurance premiums.

• A wide selection of top-tier health insurance plans.

• Optional flexible spending accounts for health care or dependent care expenses.

• Employee Assistance Program (EAP) offering confidential support.

• Wellness benefits including an on-site gym and fitness center discounts.

• 11 paid holidays annually.

• 15 vacation days and 15 sick days in your first year.

• Retirement Savings Plan with substantial employer contributions.

• Longevity Bonus to reward years of service.

• Public Service Loan Forgiveness eligibility and reimbursement for educational expenses.

• Professional development training opportunities including CEU support.

Accommodation Statement:

The Oklahoma Health Care Authority complies with applicable State and Federal civil rights laws and does not discriminate. All qualified applicants will receive consideration for employment without regard to race color sex religion disability age national origin or genetic information. If a reasonable accommodation is needed to participate in the job application or interview process to perform essential job functions and/or to receive other benefits and privileges of employment please contact the Civil Rights Coordinator at .

Notice to applicants:

Please add to the address book or safe-senders list in your email. All correspondence will come from this address. Be sure to check your junk folder. If you have questions about the status of your application you can contact the HR team at .

Note: Applications will be accepted until 11:59 PM on the day prior to the posting end date above.

Current State of Oklahoma employees must apply for open positions internally through WorkdayJobs Hub.

Equal Opportunity Employment

The State of Oklahoma is an equal opportunity employer and does not discriminate on the basis of genetic information race religion color sex age national origin or disability.

Current active State of Oklahoma employees must apply for open positions internally through the Workday Jobs Hub.

If you are needing any extra assistance or have any questions relating to a job you have applied for please click the link below and find the agency for which you applied for additional information:

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