Medical Director – Population Health, Clinical Oversight

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

📋 Description

• Provide leadership from a physician's perspective for population health initiatives, specifically targeting high-risk and high-cost groups across various business lines.

• Ensure that risk stratification and intervention methods are clinically appropriate, guiding the allocation of resources effectively.

• Direct clinical priorities aimed at enhancing outcomes, experiences, and value for specific populations, in alignment with client and contractual objectives.

• Oversee high-cost claimants and manage stop-loss reporting as necessary for contractual, audit, or customer requirements.

• Guarantee the clinical validity, accuracy, and consistency of external reports and deliverables to clients.

• Collaborate with analytics teams to optimize and standardize reporting processes, minimizing the need for manual physician involvement over time while preserving clinical integrity.

• Act as the physician escalation point for intricate, high-risk, or clinically ambiguous cases where physician insights lead to significant decisions or risk management.

• Establish and enhance criteria for physician participation to ensure efforts are concentrated on high-impact cases rather than extensive retrospective assessments.

• Advocate for standards of practice, quality oversight, and exception-based engagement models that prioritize proactive, value-added physician evaluations.

• Identify and eliminate low-value tasks for physicians through automation, delegation, and improved protocols, in collaboration with operations and product teams.

• Lead the shift from traditional case management support to a focused, impactful physician role centered on population health, governance, and critical escalations.

⛳️ Requirements

• Education: Must possess a Doctor of Medicine (MD) or Doctor of Osteopathy (DO) degree; must hold a current, unrestricted medical license in good standing. Board certification in a relevant specialty (e.g., Internal Medicine, Family Medicine, Emergency Medicine, or appropriate subspecialty) is required.

• A minimum of 7 years of clinical practice experience is required, with at least 3 to 5 years in a health plan, population health, accountable care, or value-based care environment.

• Proven experience in population health management, high-cost claimant oversight, or utilization management programs is essential.

• Prior experience in a medical director or similar physician leadership role is highly preferred.

• Strong understanding of population health concepts, including risk stratification, targeted interventions, and the assessment of clinical and financial outcomes across populations.

• Familiarity with high-cost claimants, stop-loss programs, and clinical risk management, including the impact of clinical oversight on contractual performance and client satisfaction.

• Experience in clinical governance and quality oversight, including the establishment of clinical standards, review criteria, and escalation processes for complex cases.

• Comfortable working with analytics, reporting outputs, and data-driven decision-making in both clinical and operational settings.

🏝️ Benefits

• Competitive medical, dental, and vision coverage.

• Competitive 401(k) Plan with a generous company match.

• Flexible Time Off/Paid Time Off, including 13 paid holidays.

• Protection Plans including Life Insurance, Disability Insurance, and Supplemental Insurance.

• Mental Health and Wellness benefits.