Chief Medical Officer, Health Value

About Altais:At Altais, we're on a mission to improve the healthcare experience for everyone-starting with the people who deliver it. We believe physicians should spend more time with patients and less time on administrative tasks. Through smarter technology, purpose-built tools, and a team-based model of care, we help doctors do what they do best: care for people.Altais includes a network of physician-led organizations across California, including Brown & Toland Physicians, Altais Medical Group Riverside, and Family Care Specialists. Together, we're building a stronger, more connected healthcare system.About the RoleAre you looking to join a fast-growing, dynamic team?We're a collaborative, purpose-driven group that's passionate about transforming healthcare from the inside out. At Altais, we support one another, adapt quickly, and work with integrity as we build a better experience for physicians and their patients.The Chief Medical Officer, Health Value plays a vital role in both the development and implementation of Care management and Utilization Management policy and procedures. This physician is chosen based upon knowledge of medical practice, experience in Managed Care, Utilization, Management/Quality Management programs and an ability to obtain mutual respect from and interact well with the other physicians.This role will lead and work to continually enhance the overall efficiency and quality of care for patients served by Altais Health Solutions through effective network management. As the leader of the team, this role develops and maintain collaborative functioning relationships with key providers, particularly thought leaders, across the Altais Health Solutions service delivery footprint including providing information for Altais Health Solutions to enable better understanding and skill enhancement in the medical, financial, and utilization practice functions of managed care.You will focus on:Clinical Leadership & Health Plan InterfaceAct as the primary medical leader responsible for interfacing with health plans regarding benefits, coverage issues, appeals, and administrative matters that cannot be resolved through standard channels.Attend HMO hearings on appeals and provide clinical expertise in resolving escalated medical and administrative issues.Serve as a key liaison between Altais Health Solutions, health plans, and provider organizations to ensure effective collaboration and resolution of disputes.Physician Leadership & Provider EngagementProvide clinical leadership and guidance to Primary Care Physicians (PCPs), specialists, and other providers across the AHS network.Build and maintain strong relationships with key providers and thought leaders to enhance clinical integration and provider engagement.Deliver ongoing education and training for PCPs and specialists to strengthen understanding of medical, financial, and utilization practices within managed care.Chair the Credentialing Committee, ensuring all network providers meet the required qualifications, training, and expertise to deliver quality patient care.Utilization & Care Management OversightLead and provide oversight of the Utilization Management Committee (UMC), including chairing UM Committee meetings and presenting quarterly updates to the Clinical Advisory Group.Oversee the development, implementation, and continuous refinement of UM and care management policies, procedures, and protocols to improve care coordination and ensure evidence-based clinical decision-making.Guide and facilitate clinical rounds with Case Managers and Management to monitor utilization, ensure performance metrics (e.g., bed days) are met, and manage high-risk patient cases.Serve as the lead physician liaison for UM and care management, providing clinical input into policies, system enhancements, and provider education efforts.Lead and coordinate prospective, concurrent, and retrospective reviews, including denial and/or approval of outside medical service referrals, when necessary.Quality Improvement & Patient ExperienceOversee Quality and HEDIS programs, ensuring compliance with performance standards and driving initiatives to improve patient outcomes.Lead efforts to enhance the patient experience across the AHS network through improved coordination, engagement, and satisfaction initiatives.Participate as an active member of the Quality Management Committee, providing clinical expertise and recommendations for continuous improvement.Financial & Cost of Care ManagementAccountable for Medical Loss Ratio (MLR) results across all lines of business and responsible for driving cost-effective care strategies without compromising health outcomes.Lead claims and cost analyses to identify trends, variances, and opportunities for targeted interventions that improve clinical and financial performance.Partner closely with physician leaders to ensure patient care is delivered efficiently and sustainably, balancing quality outcomes with cost containment goals.Pharmacy OversightProvide strategic leadership for the Pharmacy team, including oversight of clinical reviews, cost management, prior authorizations, and collaborative care models.Work closely with payors, providers, and internal teams to optimize pharmacy utilization while maintaining high-quality patient care.Risk Adjustment, Coding, & Documentation ImprovementOversee risk adjustment programs to ensure accurate coding and documentation, maximizing alignment with quality and reimbursement objectives.Provide leadership on initiatives aimed at improving provider education and compliance related to coding accuracy and documentation standards.Cross-Functional Collaboration & ReportingReport directly to the AHS President and serve as a key member of the executive leadership team.Collaborate across departments to ensure seamless integration of clinical, financial, and operational strategies.Act as a trusted advisor to leadership on medical management priorities, performance initiatives, and strategic planning.The Skills, Experience & Education You BringDoctor of Medicine degree; Current Board certification, preferably in a broad-based specialty such as Internal Medicine, Family Practice, Emergency Medicine, Geriatrics, General Surgery or Pediatrics.Active and in good standing MD licensure in the state of California.A minimum of ten (10) years as a practicing inpatient and outpatient physician in a managed care environment4 years management experienceHealth plan experience in operationsExperience in a physician group modelThe Base Salary for this position is $342,000 - $385,560/yearIn addition, we provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs.Excellent medical, vision, and dental coverage401k savings plan with a company matchFlexible time off and 9 Paid HolidaysThis position will also be eligible to participate in our annual bonus programYou Share Our Mission & Values:CompassionWe act with empathy and a deep respect for the challenges faced by physicians and their patients. Our work is driven by a genuine commitment to improving lives and ensuring that care is delivered with dignity, understanding, and humanity.CommunityWe foster a culture of collaboration--with physicians, patients across the healthcare ecosystem, and among our teams. By building strong, trusted relationships, we create a unified community focused on advancing patient care and physician well-being.LeadershipWe lead with integrity and vision, setting the standard for excellence in physician support and healthcare innovation. Through collaboration and expertise, we empower others to lead, drive change, and shape the future of care.ExcellenceWe are relentlessly focused, results-driven, and accountable for delivering measurable value to physicians and the patients they serve. Our high standards reflect our commitment to excellence, operational discipline, and continuous improvement.AgilityWe embrace change as a constant and respond swiftly to the evolving needs of the healthcare industry. With flexibility and forward-thinking, we adapt, innovate, and act decisively to keep physicians at the forefront.Altais values the contribution each Team Member brings to our organization. Final determination of a successful candidate's starting pay will vary based on several factors, including, but not limited to education and experience within the job or the industry. The pay scale listed for this position is generally for candidates that meet the specified qualifications and requirements listed on this job description. Additional pay may be determined for those candidates that exceed these specified qualifications and requirements. We provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs.The anticipated pay range for this role is listed in our salary posting for transparency but may vary based on factors including the candidate's qualifications, skills, and experience. This position will also be eligible to participate in our annual bonus program.Altais and its subsidiaries and affiliates are committed to protecting the privacy and security of the personal information you provide to us. Please refer to our 'CPRA Privacy Notice for California Employees and Applicants' to learn how we collect and process your personal information when you apply for a role with us.