Chief Medical Officer – CMO

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November 14

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ProgenyHealth, LLC

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Healthcare Insurance • SaaS • Wellness

ProgenyHealth, LLC is a company focused on transforming healthcare for women, infants, and families through its integrated Maternity and NICU Care Management solutions. With over 20 years of experience, ProgenyHealth provides a comprehensive care management solution to address the maternity and NICU challenges faced by modern health plans. By identifying risks early, the company aims to prevent preterm births, NICU stays, and complications during pregnancy and after delivery. ProgenyHealth operates as a trusted partner for health plans, overseeing a full maternal and infant care continuum, creating lasting relationships, and optimizing maternal and infant healthcare economics. The company also helps solve non-clinical social drivers impacting maternal and infant health, ensuring equitable, standardized, and predictable family care.

201 - 500 employees

⚕️ Healthcare Insurance

☁️ SaaS

🧘 Wellness

📋 Description

• Leads the ProgenyHealth Medical Management program, with accountability for the performance and outcomes of the Clinical Operations Department. • Maintains and oversees the NICU Utilization Management (UM), NICU & Maternity Case Management (CM) and Quality Management (QM) Programs and monitors adherence and compliance by reviewing and analyzing company data and dashboards to measure effectiveness. • Builds customer loyalty through data-driven insights and compelling demonstration of program value. • Supports the preparation, evaluation, and presentations of client program results at periodic client meetings. • Engages and builds relationships with payer medical directors as well as hospital NICU teams, outpatient obstetric clinicians, and community partners as needed. • Provides oversight of external publications that highlight ProgenyHealth’s medical management results. • Works in close partnership with the SVP of Clinical Operations to ensure best-in-class training programs for all clinical staff. • Will assist with the implementation and successful launch of new clients, new product lines, and/or technologies, as needed. • Responsible for our continued successful accreditation by URAC and NCQA, as well as oversight of all State, Federal and Client standards/regulations necessary for ProgenyHealth to provide our services to our customers. • Leads the Medical Advisory Board and Quality Improvement Committee and manages relationships with members that include practicing physicians across the US.

🎯 Requirements

• MD/DO degree and Board-Certified in Neonatology, Obstetrics, MFM, or Pediatrics is required. • Experience or deep interest in Maternal & Infant Health desired. • MPH, MBA or MHA degree preferred • Minimum of 5 years clinical practice experience after residency • Minimum of 7-10 years in managed care with health plans preferred, or value-based care delivery or payvider models including 5+ years in a Senior leadership role overseeing UM/CM functions. • Proven track record of engaging with payer clinical executives as well as hospital NICU teams, outpatient obstetric clinicians, and community partners across behavioral health and social determinants of health • Knowledge of NICU billing and claims is highly desirable • Experience in Tableau and other standard reporting tools a plus • Experience in UM/CM/QM management and the maintenance of URAC & NCQA accreditation strongly preferred. • Understanding of clinical literature in the maternal and infant health arenas, with familiarity in clinical trial design preferred. • Must be willing to travel to company and/or client meetings, trade shows, etc. as business needs dictate. • Must have excellent computer skills and be proficient in Microsoft Office especially Excel. • Must possess an active, unrestricted license to practice medicine. • Must be willing & eligible to obtain licensure in additional states based on business needs.

🏖️ Benefits

• Health insurance • Flexible work arrangements