REMOTE - Vice President Medical Director of Clinical Programs

Position Summary

The Vice President, Medical Director, Health Plan provides senior clinical leadership across the Health Plan, with a focus on quality, affordability, compliance, clinical performance, and member outcomes. This role requires strong health plan experience, the ability to lead across functions, and the communication skills to influence clinical, operational, financial, regulatory, and executive stakeholders.

Key Responsibilities

• Partner with Health Plan senior leadership to advance clinical outcomes, affordability goals, growth targets, and overall health plan strategy.

• Provide clinical leadership across utilization management, care management, population health, quality, pharmacy, medical policy, payment policy, and clinical program development.

• 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.

Required Position Qualifications

• A 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.

Preferred Experience

• With Medicare Advantage, TRICARE, or other government-sponsored programs.

• Experience with STARS, RAF, risk adjustment, Medicare bids, HEDIS, or value-based care arrangements.

• Prior management or physician leadership experience.

• Experience supporting medical policy, payment policy, pharmacy, or clinical program development.

• Experience building relationships with network physicians, hospitals, and community providers.