Associate CMO

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey's health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds.

Responsibilities:

Strategic Clinical Leadership

• Define and execute clinical strategy aligned with Horizon's enterprise vision.

• Lead medical policy, utilization management, appeals, and clinical quality initiatives.

• Oversee multidisciplinary physical and behavioral health teams of physicians, nurses, social workers and clinical professionals.

• Drive innovation in care delivery and medical cost management.

Enterprise Collaboration & Stakeholder Engagement

• Cultivate executive-level relationships with health systems, provider organizations, and government agencies.

• Serve as a trusted spokesperson and thought leader on clinical quality and healthcare transformation.

• Partner with internal leaders to align clinical programs with business objectives.

Quality, Compliance & Accreditation

• Champion clinical quality programs and support achievement of NCQA and other accreditations.

• Ensure compliance with regulatory bodies (DOBI, NCQA, DMAHS, CMS).

• Lead integration of behavioral and physical health and pharmacy initiatives.

Network Strategy & Value-Based Care

• Collaborate with Network and Clinical Transformation teams to optimize provider performance.

• Develop high-performing physician networks and address practice variation.

• Support value-based partnerships and provider education initiatives.

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Medical Policy & Operational Excellence

• Oversee development and implementation of medical policies across all lines of business.

• Ensure alignment with national standards and independent review organizations.

• Drive operational efficiency.

• Lead dental operations and clinical support for business development efforts.

Regional Care Management Leadership

• Direct clinical operations and performance of Regional Care Model programs.

• Ensure care management excellence and client satisfaction.

• Provide strategic oversight of delegated vendors and medical cost optimization opportunities.

Education/Experience:

• MD or DO with active, unrestricted medical license.

• Board certification in an accepted medical specialty a plus or evidence of candidate remaining current with medical knowledge (e.g. up to date with NJ State CME requirements).

• Minimum 10 years of clinical experience and 7+ years in medical management leadership.

• Proven success in managed care, clinical strategy, and enterprise-level collaboration.

Knowledge, Skills & Abilities:

• Deep understanding of managed care principles and government programs (Commercial, Medicare, D-SNP, Medicaid, MLTSS).

• Expertise in utilization management, appeals, medical policy, and clinical quality.

• Exceptional leadership, communication, and stakeholder engagement skills.

• Proven people-management skills.

• Strategic thinker with strong analytical and project management capabilities.

• Proficiency in Microsoft Office and healthcare data systems.

Travel % (If Applicable):

• Travel within the States of NY, NJ and PA, as needed.

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Salary Range:

This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement

Disclaimer:
This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.