Medical Director – Population Health, Clinical Oversight

Responsibilities

• Provide physician leadership for population health priorities, with a focus on high-risk and high-cost populations across lines of business.
• Ensure the clinical appropriateness of risk stratification and intervention approaches, informing where and how resources are deployed.
• Guide clinical priorities that improve outcomes, experience, and value across targeted populations, aligned to client and contractual goals.
• Provide physician oversight for high-cost claimants and stop-loss reporting where required for contractual, audit, or customer needs.
• Ensure clinical validity, accuracy, and consistency of external reporting and client deliverables.
• Partner with analytics teams to streamline and standardize reporting processes, reducing manual physician involvement over time while maintaining clinical integrity.
• Serve as the physician escalation point for complex, high-risk, or clinically ambiguous cases where physician input drives meaningful decisions or risk mitigation.
• Define and refine criteria for physician involvement so effort is focused on high-impact scenarios rather than broad retrospective review.
• Promote standards of practice, quality oversight, and exception-based engagement models that emphasize proactive, value-added physician review.
• Identify and eliminate low-value physician work through automation, delegation, and clearer protocols, in partnership with operations and product teams.
• Lead the transition from legacy case management support toward a focused, high-impact physician role concentrated on population health, governance, and critical escalations.

Requirements

• 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.

• 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.
• 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.
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