Chief Medical Officer

The Massachusetts Department of Public Health (DPH) is seeking a Chief Medical Officer (CMO) at Western MA Hospital (WMH). The Chief Medical Officer is an essential physician leader with the opportunity to shape the quality, safety, and delivery of care across the hospital’s Medical department. Serving as both Attending Physician and senior clinical leader, the CMO provides strategic direction for medical services, guides physicians and Nurse Practitioners, and partners with hospital leadership to ensure patients receive appropriate, high-quality care at the right level of care. This role offers a meaningful opportunity to influence clinical practice, strengthen interdisciplinary collaboration, and advance a culture of continuous quality improvement within a hospital committed to excellent patient care.

The CMO will serve as a visible leader among the Medical Staff, participating in and chairing key hospital committees while collaborating closely with quality, risk, utilization review, nursing, and administrative leaders. The role provides broad influence over clinical standards, physician performance, credentialing, infection prevention and control, employee health, regulatory readiness, and compliance with applicable federal and state requirements and accrediting standards, including those of CMS and The Joint Commission.

For an experienced physician leader who values clinical excellence, accountability, collaboration, and organizational impact, this is an opportunity to help shape the future of care at WMH while directly supporting and developing a talented clinical team.

Please note: The schedule is Monday through Friday, with flexibility to adjust the schedule as needed to meet operational needs.

Please note: The incumbent will function as “Chief of Service” and as such is excluded from Bargaining Unit 7 under the MNA collective bargaining agreement. Therefore, most benefits are governed by the Commonwealth's "Red Book". (For example: your dental/vision benefits will be with the Group Insurance Commission).

Duties and Responsibilities (these duties are a general summary and not all inclusive):

· Provide executive and clinical leadership for the Medical Services and Clinical Service Departments by establishing performance objectives, communicating organizational vision, and ensuring alignment with the hospital’s mission, strategic priorities, clinical needs, educational programs, business requirements, and applicable Department of Public Health regulations.

· Partner with the Chief Executive Officer and senior leadership team on strategic planning, policy development, organizational decision-making, budget and financial management, special initiatives, clinical programming, service needs, and operational priorities, while ensuring medical services are responsive to evolving patient and organizational needs.

· Direct and oversee specialized medical care programs by establishing and maintaining clinical policies, procedures, standards, and evidence-based practices that promote high-quality, safe, efficient, compassionate, and patient-centered care. Serve as a primary care physician for assigned patients and provide medical coverage, emergency support, and on-call services as required.

· Oversee patient admissions, utilization, and hospital-level care by reviewing patient abstracts, participating in medical screening, and ensuring admissions and ongoing care meet applicable CMS, managed care, and hospital-level-of-care criteria. Collaborate with interdisciplinary teams to ensure care plans appropriately reflect utilization review requirements and patient needs.

· Lead medical quality, patient safety, and performance improvement initiatives by monitoring clinical care, documentation, and provider performance; establishing and evaluating quality improvement programs; implementing National Patient Safety Goals and evidence-based initiatives; and ensuring timely corrective action, risk management, and continuous improvement across medical services.

· Ensure regulatory, accreditation, and medical staff compliance with requirements established by The Joint Commission, CMS, Department of Public Health, Massachusetts Board of Registration in Medicine, and other applicable regulatory bodies. Oversee the development, annual review, implementation, and enforcement of Medical Staff Bylaws, Rules and Regulations, policies, procedures, and standards.

· Provide leadership and oversight to the Medical Staff governance structure by serving as Chair of designated Medical Staff and hospital committees, participating as an ex-officio member of Medical Staff committees, reviewing committee activities and minutes, addressing identified concerns, and ensuring appropriate follow-through on corrective actions and organizational priorities.

· Oversee medical staff credentialing, privileging, professional performance, and workforce development by ensuring timely and accurate credentialing processes, evaluating professional practice and competencies, recommending appointments and privileges to the Governing Body, supporting physician and advanced practitioner recruitment, and addressing performance or disciplinary matters when appropriate.

· Foster strong interdisciplinary and external partnerships by collaborating with nursing and clinical leadership to address gaps in care delivery, coordinating medical education activities, supporting employee health initiatives, and serving as a senior clinical liaison to state agencies, healthcare organizations, referral sources, and external providers regarding the hospital’s role, services, and clinical capabilities.

· Oversee the operational, contractual, and financial aspects of medical services by ensuring compliance with Commonwealth purchasing, ethical, and contractual requirements; managing provider contracts; evaluating clinical service and off-site care needs; supporting recruitment and retention initiatives; and recommending strategic clinical programs and resources that advance the hospital’s mission and patient care objectives.

Required Qualifications

· Current Massachusetts physician licensure through the Board of Registration in Medicine, with the clinical expertise and professional standing required to practice hospital-based medicine.

· Demonstrated leadership experience overseeing a complex medical staff and leading physicians, advanced practitioners, and other clinical professionals in a hospital environment.

· Strong collaborative and interpersonal skills, with the ability to build effective relationships across multidisciplinary teams, executive leadership, nursing, medical staff, and external stakeholders.

· Comprehensive knowledge of hospital-based clinical practice, including the delivery, coordination, and oversight of high-quality, safe, efficient, and patient-centered medical care.

· Expertise in quality assurance, performance improvement, patient safety, and risk management, with the ability to identify opportunities for improvement and implement sustainable clinical initiatives.

· Knowledge of healthcare accreditation, certification, and regulatory processes, including The Joint Commission (TJC), CMS certification, Health Care Quality (HCQ) reviews, MassPRO, and other applicable hospital practice review requirements.

· Working knowledge of medical staff governance and oversight, including credentialing, privileging and delineation of clinical privileges, peer review, professional practice evaluation, and related medical staff processes.

· Strong administrative and financial management capabilities, including experience overseeing budgets, managing contracts, interpreting financial reports, and understanding hospital administrative and financial systems.

· Ability to develop and advance clinical programs that align with the hospital’s mission, strategic priorities, community needs, and evolving healthcare requirements, supported by an understanding of federal regulations governing hospital clinical staff and human research activities, including National Practitioner Data Bank requirements.

· Sound knowledge of healthcare legal and ethical principles, including medico-legal considerations, medical ethics, regulatory compliance, professional accountability, and the application of these principles to clinical decision-making and medical staff leadership.

Preferred Qualifications

· Experience working within a state government healthcare environment, including familiarity with administrative, budgetary, procurement, and operational processes.

· Knowledge of Commonwealth of Massachusetts policies, regulations, and administrative requirements applicable to hospital operations and clinical services.

· Demonstrated ability to build and manage effective inter-agency relationships with state agencies, healthcare organizations, regulatory bodies, and community partners.

· Experience collaborating with government agencies and external oversight organizations to support coordinated patient care, regulatory compliance, and organizational priorities.

· Strong understanding of healthcare regulatory and accreditation standards, including requirements established by The Joint Commission, CMS, Department of Public Health, and other applicable oversight entities.

· Experience preparing for and successfully navigating regulatory surveys, accreditation reviews, audits, and external oversight processes.

· Demonstrated ability to interpret complex regulations and translate requirements into effective clinical and operational practices.

· Experience developing and maintaining strategic partnerships across multiple agencies and organizations to advance clinical programs and hospital initiatives.

· Strong strategic, analytical, and organizational skills, with the ability to evaluate regulatory, financial, and operational considerations and translate them into sound recommendations.

· Experience leading cross-functional initiatives in a highly regulated healthcare environment, with the ability to