Vice President Medical Director – Clinical Programs

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🦞 Maine, Nevada, +3 more states – Remote

🦞 Maine – Remote 🎰 Nevada – Remote 🦀 Maryland – Remote 🏰 Missouri – Remote 🍁 Vermont – Remote

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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Martin's Point Health Care

WebsiteLinkedInAll Job Openings

501 - 1000 employees

⚕️ Healthcare Insurance

🧘 Wellness

Healthcare Insurance • Wellness

Martin's Point Health Care is a healthcare organization committed to serving its local communities through high-quality primary and specialty care services. The organization places a strong emphasis on creating a positive workplace culture, recognizing employee contributions, and fostering workforce diversity. Martin's Point Health Care offers a range of career opportunities across various departments, from healthcare providers to corporate roles, and supports employee growth through competitive compensation, development programs, and generous perks. Additionally, the company is recognized for its community impact efforts, raising significant funds for community organizations and encouraging employee volunteerism.

📋 Description

• Provide clinical leadership across utilization management, care management, population health, quality, pharmacy, medical policy, payment policy, and clinical program development • Partner with Health Plan senior leadership to advance clinical outcomes, affordability goals, growth targets, and overall health plan strategy • Lead cross-functional collaboration among Medical Directors, Medical Economics, Quality, Network, Compliance, Pharmacy, Operations, and Clinical Programs • Support compliance with government program requirements, including clinical appeals and grievances, using sound clinical evidence and medical judgment • Use clinical, quality, utilization, and financial data to identify trends, assess performance, and recommend actionable interventions • Develop strategies to improve medical expense management, appropriate utilization, quality of care, and population health outcomes • Provide clinical input into product design, Medicare bids, risk adjustment, STARS, HEDIS, value-based arrangements, and clinical integration initiatives • Communicate complex clinical, regulatory, and operational information clearly to executive, provider, clinical, and non-clinical audiences • Support appropriate utilization of services through strong partnership with Utilization Management, Care Management, and physician leaders • Represent the organization with regulatory entities, professional societies, providers, network partners, and external stakeholders, as appropriate • Build and strengthen relationships with hospitals, physicians, and other health care providers to support network engagement and performance goals • Support strategies tied to population health, care management, provider performance, and contractual outcomes • Lead, support, and develop physician leaders and clinical team members, as assigned

🎯 Requirements

• Medical Degree, MD or DO, from an accredited medical school • Board certification in a relevant medical discipline or specialty • Active, unrestricted medical license, or ability to obtain licensure in a state relevant to the role • Ten or more years of professional experience, including clinical practice experience • Health plan, managed care, or payer experience in a Medical Director or comparable physician leadership role • Demonstrated experience working across health plan functions, such as utilization management, care management, quality, appeals and grievances, population health, medical economics, provider relations, pharmacy, compliance, or network • Experience using clinical, quality, utilization, or financial data to guide decisions, develop interventions, and measure outcomes • Strong cross-functional leadership skills, with the ability to align clinical, operational, financial, and regulatory priorities • Strong verbal, written, and presentation skills, including the ability to communicate effectively with executive, clinical, provider, operational, and regulatory audiences • Ability to influence, collaborate, and build credibility with internal and external stakeholders • Strong analytical, problem-solving, and decision-making skills • Demonstrated alignment with Martin’s Point Health Care values.

🏖️ Benefits

• Health insurance • 401(k) matching • Paid time off • Flexible working arrangements • Professional development opportunities