Medicare & Value-Based Care Senior Director

Capital District Physicians Health Plan Inc; Buffalo (NY); Hybrid; USD 250,000 - 375,000; Full time

Job summary

Capital District Physicians Health Plan Inc (CDPHP) seeks a Senior Medical Director to lead strategic clinical initiatives across value-based care, population health, and medical management. You will partner with line of business leaders, network contracting, actuarial, finance, and analytics to improve outcomes and total cost of care.

The role requires MD/DO with board certification and NY license, strong analytics, and proven ability to drive cross-functional performance while ensuring

Qualifications

• Must be a licensed physician (MD or DO) with board certification.
• Experience leading medical management, quality improvement, and risk programs.
• Strong analytical/financial acumen tied to clinical interventions.
• Ability to influence physicians and cross-functional teams.
• Working knowledge of CMS, NYS and NCQA requirements.

Responsibilities

• Serve as senior clinical advisor to line of business leadership on strategy and regulatory priorities.
• Develop and execute clinical strategy aligned with growth, quality, and financial objectives.
• Lead medical management programs to optimize care and reduce avoidable utilization.
• Create provider performance benchmarks, scorecards, and improvement plans.
• Collaborate on quality improvement strategies and risk-adjusted performance.
• Ensure compliance with CMS, NYS, NCQA, and related regulations.

Skills

Strategic leadership

Healthcare analytics

Communication skills

Influence across stakeholders

CMS/NY reimbursement knowledge

Education

MD or DO

Board certification

Active NYS medical license

Job description

Capital District Physicians Health Plan Inc (CDPHP) seeks a Senior Medical Director to lead strategic clinical initiatives across value-based care, population health, and medical management. You will partner with line of business leaders, network contracting, actuarial, finance, and analytics to improve outcomes and total cost of care.

The role requires MD/DO with board certification and NY license, strong analytics, and proven ability to drive cross-functional performance while ensuring