Chief Medical Officer

About the Company

Antidote Health is a tech-driven health insurance company on a mission to make healthcare easier, more accessible, and more affordable. We’re rethinking how healthcare works—using technology to remove the friction, complexity, and delays that define the traditional system. Instead of navigating paperwork, long waits, and disconnected experiences, we’re building a simpler, more connected way for people to get care.

Our platform combines health coverage, virtual care, and a modern member experience into one seamless system designed to help people actually use their benefits.

We offer Affordable Care Act (ACA) health plans in Arizona, Ohio, Georgia, and Texas, and we’re growing quickly. We’re building a company focused on solving real problems—with a real impact on people’s lives.

Position Overview

The Chief Medical Officer (CMO) is a member of the executive leadership team, reporting directly to the Chief Executive Officer. The CMO provides strategic and executive oversight of Clinical Operations, provider performance and partnerships, Quality Management, Population Health, and clinical performance across Antidote’s ACA Marketplace health plans.

This position requires extensive health plan leadership experience, strong business and financial acumen, and a demonstrated ability to leverage technology and innovation. The CMO will develop and execute clinical strategies that improve health outcomes, manage medical and risk adjustment costs, ensure regulatory compliance, and support sustainable organizational growth.

This is a full time hybrid opportunity, we are seeking someone in the greater NYC area willing to be in our office on Tuesdays and Wednesdays.

Leadership Profile

The ideal candidate is a positive, resilient, and solution-oriented leader who brings energy and optimism to complex challenges. They think with agility, adapt quickly as priorities evolve, and are comfortable moving between strategic decisions and hands-on execution. Most importantly, they share Antidote Health’s belief that access to quality healthcare is a basic right and are motivated to build a simpler, more affordable, and more accessible healthcare experience for everyone.

Key Responsibilities

Executive Leadership & Company Strategy

• Serve as a member of the executive leadership team, contributing to enterprise strategy, business performance, organizational priorities, and long-term growth.

• Demonstrate a holistic enterprise mindset, making decisions that balance clinical quality, financial sustainability, operational efficiency, member experience, and business objectives.

• Partner with the CEO and executive leadership to identify opportunities, mitigate enterprise risks, and establish strategic priorities.

• Support ACA Marketplace expansion and organizational growth through scalable, financially responsible clinical strategies.

• Translate enterprise objectives into actionable priorities with clear accountability, measurable outcomes, and effective execution.

Functional Strategy & Execution

• Develop and execute an integrated clinical strategy encompassing Utilization Management (UM), Care Management (CM), Disease Management (DM), Behavioral Health, Population Health, Telehealth, and Quality Management.

• Provide executive oversight of Clinical Operations and Quality, ensuring operational effectiveness, regulatory compliance, clinical quality, and alignment with business objectives.

• Lead medical cost management strategies targeting avoidable utilization, high-cost members, preventable admissions, readmissions, and unnecessary healthcare expenditures.

• Oversee NCQA accreditation, HEDIS performance, the ACA Quality Rating System (QRS), clinical quality improvement, and evidence-based medical policies.

• Champion technology-driven clinical transformation, including AI, automation, clinical decision-support systems, interoperability, and advanced analytics.

• Establish measurable performance standards for internal clinical programs and delegated vendors.

• Oversee clinical activities and clinical staffing to ensure appropriate coverage, quality, efficiency, and alignment with organizational priorities; establish and monitor key clinical performance, quality, and productivity metrics.

• Provide clinical oversight of PBM and pharmacy programs, including formulary development and additions, formulary compliance, utilization management, and implementation of quality- and cost-improvement initiatives.

Organizational Leadership

• Build and lead high-performing Clinical Operations and Quality teams with the expertise and capabilities required to support organizational growth.

• Establish clear organizational structures, decision-making authority, performance expectations, and accountability across clinical functions.

• Empower functional leaders to manage operational execution while maintaining executive oversight of strategy, performance, and outcomes.

• Evaluate staffing models, resource allocation, and organizational capabilities to ensure efficient, scalable operations.

• Develop internal talent, strengthen leadership capabilities, and establish succession planning to support organizational continuity.

• Foster a culture of collaboration, innovation, accountability, and continuous improvement.

Cross-Functional Partnership

• Build effective partnerships across Finance, Actuarial, Network Management, Pharmacy, Technology, Product, Compliance, Legal, Member Services, and other business functions.

• Partner with Finance and Actuarial to evaluate medical cost trends, optimize utilization, and support medical loss ratio and financial performance objectives.

• Collaborate with Network Management and Member Services to improve access to care, provider performance, member engagement, and retention.

• Partner with Product and Technology to implement clinical solutions that improve operational efficiency, interoperability, and member experience.

• Facilitate enterprise-wide decisions, balancing competing priorities and promoting shared accountability for organizational outcomes.

• Communicate strategic priorities, performance results, risks, and recommendations effectively to executive leadership and the Board.

• Work with third-party partners and delegated entities to support quality, efficiency, delegation oversight, and performance management, including review of key performance indicators and opportunities for improvement.

Governance, Risk & Stewardship

• Partner with Compliance to establish and maintain effective clinical governance structures that ensure appropriate oversight and accountability across Clinical Operations and Quality.

• Provide executive oversight of clinical governance committees, including Quality Management, Utilization Management, credentialing, and other applicable medical oversight committees.

• Oversee clinical decision-making standards, medical necessity criteria, physician review processes, and delegated clinical arrangements.

• Partner with technology and data teams to ensure responsible adoption of AI and emerging technologies with appropriate safeguards for patient safety, data privacy, and regulatory compliance.

Qualifications

Required Qualifications

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree from an accredited medical institution.

• Active, unrestricted license to practice medicine in at least one U.S. state, with eligibility to obtain additional state licenses as required.

• Board certification in a recognized medical specialty.

• Minimum of 10 years of experience within a U.S. health plan or managed care organization, including at least five years in a senior physician leadership or executive capacity.

• Demonstrated hands-on ability to operate effectively in a fast-paced startup environment, balancing strategic leadership with direct execution as needed.

• Leadership experience within commercial health insurance, preferably including ACA Marketplace/Qualified Health Plan (QHP) operations.

• Extensive knowledge of health plan clinical operations, including Utilization Management, Care Management, Disease Management, Behavioral Health, Population Health, and clinical quality improvement.

• Demonstrated experience providing executive oversight of clinical operations and quality functions within a complex, multistate health plan or managed care environment.

• Proven experience developing and executing medical cost management strategies, evaluating utilization trends, improving clinical outcomes, and supporting medical loss ratio performance.

• Comprehensive understanding of applicable federal and state managed care regulations, CMS requirements, NCQA accreditation standards, HEDIS measures, and healthcare quality reporting requirements.

• Demonstrated experience overseeing delegated clinical vendors, establishing performance expectations, evaluating service delivery, and ensuring regulatory and contractual compliance.

• Strong technological proficiency, with demonstrated experience leading or implementing clinical technology solutions, including AI-enabled workflows, automation, clinical decision-support systems, data analytics, and healthcare interoperability.

• Strong financial and business acumen, including experience developing and managing budgets, evaluating clinical program return on investment, and aligning clinical strategies with enterprise financial objectives.

• Demonstrated enterprise-wide strategic thinking.

• Proven ability to collaborate effectively with executive leadership.

• Demonstrated commitment to evidence-based medicine, ethical leadership, patient safety, health equity, clinical quality, and continuous improvement.

Preferred Qualifications

• Previous experience serving as a Chief Medical Officer, Deputy Chief Medical Officer, Vice President of Medical Affairs, or equivalent senior medical executive within a health plan.

• Direct leadership experience within ACA Marketplace/QHP insurance products across multiple states.

• Experience with integrated payer-provider models, virtual care delivery, and telehealth operations.

• Experience with NCQA accreditation surveys, HEDIS performance improvement, and health plan quality rating initiatives.

• Familiarity with QNXT or comparable health plan administration platforms, MCG or equivalent evidence-based clinical criteria solutions, and clinical workflow technology.

• Experience overseeing clinical operations during rapid membership growth, geographic expansion, vendor transitions, or organizational restructuring.

• Demonstrated success integrating emerging technologies into healthcare operations while maintaining appropriate clinical oversight, regulatory compliance, and measurable return on investment.

Compensation and Benefits

• Base salary range: $xx (commensurate with experience and location)
• Eligible for equity
• Comprehensive benefits package including medical, dental, vision
• 401(k)
• Paid vacation and sick time and company holidays

Company Standards and Expectations

• Employment is at-will, meaning either the employee or the company may terminate employment at any time, with or without cause, in accordance with applicable law
• Employees are expected to adhere to all company policies, including confidentiality, data protection, and code of conduct
• Responsibilities may evolve based on business needs, and flexibility is expected as the company scales
• Compliance with all applicable federal, state, and local laws and regulations is required

Equal Opportunity Statement

Antidote Health is an equal opportunity employer and makes employment decisions without regard to race, color, religion, sex, national origin, age, disability, veteran status, or any other protected status under applicable law.

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