Medical Director, Population Health & Clinical Oversight

Key Accountabilities

• Population Health Clinical Oversight and Strategy (45%)
• High-Cost Claimant and Stop-Loss Clinical Oversight (30%)
• Targeted Clinical Governance and Escalation (15%)
• Physician Role Optimization and Work Reduction (10%)

A Day in the Life

• Provide real-time clinical guidance on prioritized high-cost claimants, escalated cases, and population health initiatives.
• Review and validate clinical components of high-cost claimant and stop-loss reporting.
• Participate in cross-functional forums to set and refine population health strategies.
• Serve as the final clinical decision-maker for complex or high-risk member scenarios.
• Partner with operations, product, and technology to redesign workflows and clinical policies.
• Monitor emerging trends in clinical utilization, risk, and outcomes.

What We Are Looking For

• Education & Experience
• Education: Doctor of Medicine (MD) or Doctor of Osteopathy (DO) degree; current, unrestricted medical license in good standing.
• Board certification in an applicable specialty (e.g., Internal Medicine, Family Medicine, Emergency Medicine, or relevant subspecialty) required.
• Experience: 7+ years of clinical practice experience, with at least 3–5 years in a health plan, population health, accountable care, or value-based care setting.
• Demonstrated experience with population health management, high-cost claimant oversight, or utilization management programs.
• Prior leadership experience in a medical director or equivalent physician leadership role strongly preferred.

Clinical & Domain Expertise

• Deep understanding of population health concepts, including risk stratification, targeted interventions, and measurement of clinical and financial outcomes across populations.
• Familiarity with high-cost claimants, stop-loss programs, and clinical risk management, including how clinical oversight influences contractual performance and client satisfaction.
• Experience in clinical governance and quality oversight, including setting clinical standards, review criteria, and escalation pathways for complex cases.
• Comfort working with analytics, reporting outputs, and data-driven decision-making in a clinical or operational context.

Professional Competencies

• Strategic Clinical Leadership: Ability to connect day-to-day clinical decisions and governance activities to broader population health, contractual, and business objectives.
• Analytical Judgment: Strong clinical reasoning skills with the ability to interpret complex medical histories, utilization patterns, and outcomes data to guide high-stakes decisions.
• Stakeholder Communication: Proven ability to translate clinical and analytic insights into clear, actionable guidance for non-physician stakeholders, including operations, clients, and executive leaders.
• Change Management & Influence: Comfortable leading change across multidisciplinary teams, including evolving physician roles, workflows, and review criteria.
• Collaboration: Effective collaborator in a matrixed environment, able to align clinical, operational, analytic, and product stakeholders around shared goals.
• Operational Discipline: High attention to detail and consistency in clinical decision-making, documentation, and review processes, recognizing the contractual and member implications of physician judgments.
• Innovation & Continuous Improvement: Mindset focused on simplifying processes, reducing low-value work, and continuously improving clinical models and workflows over time.

About the Role

Transcarent is the One Place for Health and Careᵀᴹ, bringing medical, pharmacy, and point solutions together with the WayFindingᵀᴹ experience, the first and only generative AI-powered health and care platform for health consumers. Our WayFinding experience, paired with transparent and consumer-driven pharmacy care, 2nd.MD expert medical opinions, and virtual primary care, works seamlessly with comprehensive Care Experiences – Cancer Care, Surgery Care, and Weight Health – to support people with all of their health needs, simple or serious. More than 1,700 employers and health plans rely on us to provide information, guidance, and care, empowering health consumers with more choice, an experience they love, access to higher-quality care, and lower costs for 21 million Members.

Benefits

• Competitive medical, dental, and vision coverage
• Competitive 401(k) Plan with a generous company match
• Flexible Time Off/Paid Time Off, 13 paid holidays
• Protection Plans including Life Insurance, Disability Insurance, and Supplemental Insurance
• Mental Health and Wellness benefits

Total Rewards

Individual compensation packages are based on a few different factors unique to each candidate, including primary work location and an evaluation of a candidate’s skills, experience, market demands, and internal equity. Salary is just one component of Transcarent's total package. All regular employees are also eligible for the corporate bonus program or a sales incentive (target included in OTE) as well as stock options.

EEO Statement

We celebrate diversity and are committed to creating an inclusive environment for all employees. If you are a person with a disability and require assistance during the application process, please don’t hesitate to reach out!