Medicare & Value-Based Care Medical Director

Univera Healthcare; Buffalo (NY); On-site; USD 250,000 - 375,000; Full time

Benefits offered by this job

Remote work possible

Job summary

Univera Healthcare in Buffalo, NY seeks a Senior Medical Director to lead clinical strategy across value-based care, population health and medical management, driving quality, cost of care and member outcomes.

You will partner with networks, actuaries, quality, pharmacy and analytics to align CMS requirements, optimize case management, and advance care transformation while maintaining regulatory compliance and member privacy.

Qualifications

• MD or DO with NYS medical license required.
• Three (3) years of Medical Director experience for a health plan or equivalent required.
• Experience influencing physicians, providers, and cross-functional teams.

Responsibilities

• Serve as senior clinical advisor on strategy, population health, medical cost, quality, and regulatory priorities.
• Translate clinical and financial data into actionable strategies and priorities.
• Establish provider performance expectations, benchmarks, and scorecards.
• Provide clinical leadership for medical management programs including utilization management and prior authorization.
• Identify opportunities to improve preventive care, chronic disease management, and member experience.

Skills

Clinical leadership

Population health

Value-based care

Medical management

Regulatory knowledge

Education

MD or DO with NYS medical license

Job description

Univera Healthcare in Buffalo, NY seeks a Senior Medical Director to lead clinical strategy across value-based care, population health and medical management, driving quality, cost of care and member outcomes.

You will partner with networks, actuaries, quality, pharmacy and analytics to align CMS requirements, optimize case management, and advance care transformation while maintaining regulatory compliance and member privacy.