Medical Director – Care & Case Management

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee the care, case, and utilization management programs while establishing clinical direction.

• Take responsibility for the outcomes, performance, and quality metrics of Included Health’s CCM and UM programs.

• Act as the clinical escalation point for care, case, and utilization management initiatives.

• Establish and uphold clinical standards, evidence-based care pathways, and expectations for clinical quality.

• Manage clinical KPIs, assess performance gaps, and redesign workflows to address these issues.

• Analyze data to identify outliers and ineffective workflows, driving resolution and improvement.

• Conduct weekly performance reviews, manage escalation triage, and track action items.

• Advance the clinical operating model across adult, maternity, and pediatric populations.

• Collaborate with Product and Engineering teams to design, validate, and integrate AI and agentic tools into clinical workflows.

• Develop new programs and care models, determining their scalability across various populations and clients.

• Lead, manage, and foster the growth of clinical leaders and teams.

• Perform performance reviews, coaching, and provide feedback for direct reports.

• Attract and maintain a strong, diverse pool of clinical talent.

• Coordinate care with clinical leaders and cross-functional stakeholders for members with multi-specialty needs.

• Represent care management in cross-functional initiatives, pilots, and strategic planning related to complex care.

• Implement quality assurance processes in collaboration with the Quality team.

• Report directly to the Senior Medical Director, Complex Care.

⛳️ Requirements

• Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO).

• Board certified in internal medicine, family medicine, med-peds, or a related specialty.

• A minimum of 7 years of post-residency clinical experience.

• At least 5 years in a healthcare leadership position with direct oversight of clinical teams or programs.

• Experience managing other clinical leaders (managing managers).

• Active, unrestricted medical license in good standing in the state of residence.

• Active multi-state licensure or willingness to obtain it.

• Proven record of achieving operational KPIs, such as productivity, clinical quality, and engagement, in a large-scale, performance-driven environment.

• Experience in digital health or virtual care delivery models is preferred.

• Comfort with integrating clinical AI tools into daily workflows and care delivery is preferred.

• Understanding of medical, behavioral, and social factors that contribute to poor outcomes and avoidable costs across complex populations is preferred.

• Residing in a physician compact-eligible state is preferred.

🏝️ Benefits

• Remote-first culture.

• 401(k) savings plan through Fidelity.

• Comprehensive medical, vision, and dental coverage through various medical plan options, including disability insurance.

• Paid Time Off (PTO).

• Discretionary Time Off (DTO).

• 12 weeks of 100% Paid Parental leave.

• Fertility coverage.

• $25,000 for surrogacy/adoption.

• Paid leave for unsuccessful treatments, adoption, or pregnancies.

• Work-From-Home reimbursement to support home office collaboration.

• Bonus.

• Equity.