This senior executive position is the Chief Medical Officer (CMO) of the Sendero Health Plans, Inc. The Chief Medical 
Officer (CMO) serves as the senior clinical leader for the HMO and other insured products as indicated, is 
responsible for oversight and strategic leadership of all Medical Management and Quality functions. Reporting 
directly to the CEO, the CMO will lead Utilization Management, Concurrent Review, Case Management, Social Work 
teams, Community Health Workers (CHWs), and the Quality Improvement Department. This role ensures the 
delivery of high-quality, cost-effective care while maintaining compliance with state and federal regulations. The 
position collaborates closely with the System EVP & Chief Medical Officer to ensure health plan clinical strategies 
align with broader system-level goals, while retaining responsibility for medical management specific to Sendero 
Health Plans’ unique regulatory and operational environment.

Essential Functions
Medical Management Leadership
• Direct and oversee all Medical Management functions including Utilization Management, Concurrent Review, Case 
Management, Social Workers, and Community Health Workers. 
• Oversee the management of the pharmacy benefit program, including the implementation of programs to 
promote efficient use of HMO’s resources related to drug utilization. 
 • Provide clinical leadership in the development and execution of care management strategies that support 
member health outcomes, cost containment, and regulatory compliance. 
 • Develop and implement programs to increase the efficient delivery of quality care for low-income and high-risk 
populations. 
• Provides oversight of Pharmacy & Therapeutics Committee and/or other clinical committees as assigned. 
• Work in collaboration with the System EVP & Chief Medical Officer to ensure consistency and communication 
across the Enterprise.
Quality Improvement Oversight
• Lead the HMO’s Quality Improvement Department to design, implement, and monitor programs focused on 
clinical quality, patient safety, and regulatory performance measures (e.g., HEDIS, CAHPS and NCQA). 
• Ensure continuous performance, improvement and achievement of quality benchmarks. 
• Provides leadership in the Quality Improvement (QI) reporting to the Board of Directors on Quality Improvement 
activities as mandated and implement CM/DM protocols, risk-stratification, and policies based on evidence-based 
medicine, best practices. and NCQA Accreditation standards. 
• Leads development for value-based Provider contracts and quality incentives for the health plan. 
• Ensure that network providers have been credentialed and re-credentialed according to the Health Plan’s 
credentialing NCQA policies and procedures. and collaborates with the System EVP & Chief Medical Officer to 
ensure consistency with system-wide credentialing standards as relevant. 
• Manages a potential quality of care issue and facilitates the peer review process to take appropriate action, while 
coordinating with the System EVP & Chief Medical Officer on any systemic implications or shared providers, as 
indicated. 

 Work in collaboration with the System EVP & Chief Medical Officer to ensure consistency and communication 
across the Enterprise regarding Quality Improvement initiatives.
Regulatory and Compliance Oversight
• Ensure full compliance with the Texas Department of Insurance (TDI), Centers for Medicare & Medicaid Services 
(CMS), NCQA and all relevant accrediting and regulatory bodies. 
• Oversee and the support the NCQA Accreditation for the Health Plan seeking to ensure accreditation at the 
highest standards. 
• Serve as a primary clinical contact during all audits and regulatory reviews.
Clinical Policy Development
• Lead the development and periodic review of Benefit Plans’ clinical guidelines, utilization criteria, and medical 
policies. 
• Guide clinical decision-making processes that align with evidence-based medicine and organizational goals. Work 
in collaboration with the System EVP & Chief Medical Officer to ensure consistency and communication across the 
Enterprise.
Cross Department Collaboration
• Partner with departments including Provider Network, Pharmacy, Member Services, Operations, Finance and 
Compliance to promote integrated strategies supporting health outcomes and member experience. Work in 
collaboration with the System EVP & Chief Medical Officer to ensure consistency and communication across the 
Enterprise. 
 • Serve as a clinical subject matter expert in executive leadership forums.
Staff Leadership & Development
• Directly manage the Sendero Medical Directors and provide leadership to clinical and non-clinical staff across all 
Medical Management areas for Sendero clinical team. 
• Directly supervises the VP of Medical Management assisting department staff in understanding the broad and 
deep issues of the healthcare environment both locally and nationally. 
 • Participates as member of company Leadership team
 • Foster a culture of accountability, professional development, and operational excellence in collaboration with the 
System EVP & Chief Medical Officer to ensure consistency and communication across the Enterprise.
Community Engagement
• Provide clinical leadership for community health initiatives, working with case managers, MSWs and CHWs to 
address social determinants of health and promote health equity among the member population.
• Participate in development and implementation of the mission, vision and values of the Health Plan, including 
comprehensive healthcare coverage and arrangement of innovative, high quality and cost-effective medical 
services. 
• Develops and maintains strong relationships with external stakeholders, such as providers and community-based 
agencies, including regulatory agencies. 
 • Work in collaboration with the System EVP & Chief Medical Officer to ensure consistency and communication 
across the Enterprise related to community outreach. 
• Supports overall regional and corporate goals to ensure continued growth and sustainability of the Health Plan.
People Management/Department Management/Business Unit Management
• Direct service line operations and execution of initiatives, goals and programs. 
• Manage implementation of new service line initiatives and ensure coordination of strategy and initiatives. 
• Adheres to all local, state, and federal regulations 
• Participates as member of company Leadership team 
• Provides oversight and direction to the enterprise’s departmental efforts 
• Develops and oversees departmental strategy to meet and support the strategic plan 
• Create recruiting model that provides candidates with a superior experience and enables leaders to identify 
employees who will live the company mission every day. 
• Builds and maintains a superior departmental support team serving all employees in a manner that is consistent 
with the company’s Core Beliefs 
• Leads complex organizational change efforts 
• Selects personnel for hire and promotion; takes appropriate actions regarding counseling, disciplinary actions, 
demotion and termination 
• Directs, supports and coaches direct reports 
• Responds proactively to employee needs and concerns 
• Develops “experts” and “expertise” throughout the department and seeks employee input 
• Facilitates consensus among divergent groups 
• Minimizes staff turnover 

• Acknowledges and rewards employees’ strengths and accomplishments 
• Evaluates assigned staff performance and competency, providing direct feedback 
• Assesses learning needs, develops competency plans and provides opportunities for learning

MINIMUM EDUCATION: Doctoral or Professional Degree in a postgraduate clinical specialty 

Required: Minimum 5 years of progressive leadership experience in Medical Management within a managed care or health plan environment. 

In-depth knowledge of utilization management, case management, concurrent review, quality improvement, and population health management.

Demonstrated understanding of applicable HMO regulations and standards including TDI, CMS, NCQA, 
HEDIS, and CAHPS.

Outstanding clinician with strong clinical references. Required

Required upon hire:

M.D. or D.O. Board Certified in  a postgraduate clinical specialty, current unrestricted license from the Texas Medical  Board; a Texas Medical Board  Administrative license may NOT  be substituted for the Texas  license.

Must be free of sanctions or restrictions from Medicaid or  any other government-funded  programs.