Senior Medicare & Value-Based Care Leader – Remote

Capital District Physicians Health Plan Inc; Jamestown (NY); On-site; USD 250,000 - 375,000; Full time

Benefits offered by this job

Remote work on case-by-case basis

Job summary

Capital District Physicians Health Plan Inc is seeking a Senior Medical Director to lead clinical and business strategy across value-based care, population health, medical management, and quality improvement, while ensuring CMS compliance.

The role partners with line of business leadership, network and provider contracting, actuary, finance, analytics, and operations to improve outcomes, member experience, provider performance, and total cost of care.

Qualifications

• MD or DO with NYS medical license.
• Three+ years as Medical Director in a health plan or equivalent.
• Experience designing/shared savings and value-based arrangements.
• Strong analytical, financial acumen and cross-functional influence.

Responsibilities

• Advise line of business on strategy, population health, quality and regulatory priorities.
• Develop clinical strategy aligned with growth, quality and financial goals.
• Translate data into actionable clinical strategies and operating priorities.
• Set provider performance expectations, scorecards and improvement plans.
• Lead medical management programs to optimize site of care and reduce avoidable costs.
• Collaborate with Quality and Compliance on CMS and NCQA initiatives.

Skills

Strategic leadership

Influence physicians

Analytical & financial acumen

Communication skills

Managed care knowledge

Education

MD or DO with NYS Medical license

Job description

Capital District Physicians Health Plan Inc is seeking a Senior Medical Director to lead clinical and business strategy across value-based care, population health, medical management, and quality improvement, while ensuring CMS compliance.

The role partners with line of business leadership, network and provider contracting, actuary, finance, analytics, and operations to improve outcomes, member experience, provider performance, and total cost of care.