Senior Medical Director, Clinical Programs & Strategy

Martin’s Point Health Care; United States; Remote; USD 250,000 - 350,000; Full time

Job summary

Martin’s Point Health Care seeks a Vice President, Medical Director, Health Plan to provide senior clinical leadership across the Health Plan, with focus on quality, affordability, compliance, and member outcomes. The role requires strong health plan experience and the ability to influence executive stakeholders.

You will lead utilization management, care management, population health, quality, and clinical program development, collaborating across Medical Directors, Quality, Compliance, and

Qualifications

• MD or DO from an accredited medical school.
• Board certification in a relevant medical discipline.
• Active, unrestricted medical license, or ability to obtain licensure in a state relevant to the role.
• Ten or more years of professional experience, including clinical practice.
• Health plan, managed care, or payer experience in a Medical Director or comparable physician leadership role.
• Experience using clinical, quality, utilization, or financial data to guide decisions, develop interventions, and measure outcomes.
• Strong cross-functional leadership skills, with the ability to align clinical, operational, financial, and regulatory priorities.
• Strong verbal, written, and presentation skills, including the ability to communicate effectively with executive, clinical, provider, operational, and regulatory audiences.
• Demonstrated alignment with Martin’s Point Health Care values.

Responsibilities

• Partner with Health Plan senior leadership to advance clinical outcomes, affordability goals, growth targets, and overall health plan strategy.
• Provide clinical leadership across utilization management, care management, population health, quality, pharmacy, medical policy, payment policy, and clinical program development.
• Lead cross-functional collaboration among Medical Directors, Medical Economics, Quality, Network, Compliance, Pharmacy, Operations, and Clinical Programs.
• Support compliance with government program requirements, including clinical appeals and grievances, using sound clinical evidence and medical judgment.
• Use clinical, quality, utilization, and financial data to identify trends, assess performance, and recommend actionable interventions.
• Develop strategies to improve medical expense management, appropriate utilization, quality of care, and population health outcomes.
• Provide clinical input into product design, Medicare bids, risk adjustment, STARS, HEDIS, value-based arrangements, and clinical integration initiatives.
• Communicate complex clinical, regulatory, and operational information clearly to executive, provider, clinical, and non-clinical audiences.
• Support appropriate utilization of services through strong partnership with Utilization Management, Care Management, and physician leaders.
• Represent the organization with regulatory entities, professional societies, providers, network partners, and external stakeholders, as appropriate.
• Build and strengthen relationships with hospitals, physicians, and other health care providers to support network engagement and performance goals.
• Support strategies tied to population health, care management, provider performance, and contractual outcomes.
• Lead, support, and develop physician leaders and clinical team members, as assigned.

Skills

Cross-functional leadership

Communication skills

Analytical skills

Influence stakeholders

Strategic thinking

Education

MD/DO

Board certification

Medical license

Job description

Martin’s Point Health Care seeks a Vice President, Medical Director, Health Plan to provide senior clinical leadership across the Health Plan, with focus on quality, affordability, compliance, and member outcomes. The role requires strong health plan experience and the ability to influence executive stakeholders.

You will lead utilization management, care management, population health, quality, and clinical program development, collaborating across Medical Directors, Quality, Compliance, and