远程 - 医疗总监（临床项目）
REMOTE - Vice President Medical Director of Clinical Programs
加入Martin's Point Health Care——一家创新的非营利医疗保健组织，为缅因州及更广泛地区的人们提供医疗照护和保障。作为“人们帮助人们的团队”，Martin's Point的员工致力于改变我们的医疗体系，同时打造更健康的社区。Martin's Point的员工享受一种信任与尊重的文化，我们的价值观——照顾自己和他人、持续学习、互相帮助、享受乐趣——每天都在实践中体现。加入我们，亲自体验为什么Martin's Point自2015年以来一直被认证为“最佳工作场所”。
职位概述
医疗总监、健康计划副总裁在健康计划中提供高级临床领导力，重点关注质量、可负担性、合规性、临床表现和会员结果。该职位需要丰富的健康计划经验，能够跨职能领导，并具备影响临床、运营、财务、监管和高管利益相关者的沟通能力。
职位描述
员工需支持并展示Martin’s Point Health Care的使命、愿景和核心价值观。
主要职责包括：
- 与健康计划高级管理层合作，推动临床结果、可负担性目标、增长指标和整体健康计划战略。
- 在利用管理、护理管理、人群健康、质量、药房、医疗政策、支付政策和临床项目开发等方面提供临床领导力。
- 在医学主任、医学经济、质量、网络、合规、药房、运营和临床项目之间推动跨职能协作。
- 支持符合政府项目要求的合规性，包括临床申诉和投诉，使用可靠的临床证据和医学判断。
- 利用临床、质量、利用和财务数据识别趋势，评估绩效，并推荐可行的干预措施。
- 制定策略以改善医疗费用管理、适当利用、护理质量和人群健康结果。
- 为产品设计、医保投标、风险调整、STARS、HEDIS、基于价值的安排和临床整合计划提供临床意见。
- 向高管、供应商、临床和非临床受众清晰传达复杂的临床、监管和运营信息。
- 支持服务的适当利用
查看英文原文
Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.
Position SummaryThe Vice President, Medical Director, Health Plan provides senior clinical leadership across the Health Plan, with a focus on quality, affordability, compliance, clinical performance, and member outcomes. This role requires strong health plan experience, the ability to lead across functions, and the communication skills to influence clinical, operational, financial, regulatory, and executive stakeholders.
Job Description
Employees are expected to support and demonstrate the mission, vision, and core values of Martin’s Point Health Care.
Key responsibilities include:
- 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.
Position Qualifications
Required
- Medical Degree, MD or DO, from an accredited medical school.
- Board certification in a relevant medical discipline or specialty.
- 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 experience.
- Health plan, managed care, or payer experience in a Medical Director or comparable physician leadership role.
- Demonstrated experience working across health plan functions, such as utilization management, care management, quality, appeals and grievances, population health, medical economics, provider relations, pharmacy, compliance, or network.
- 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.
- Ability to influence, collaborate, and build credibility with internal and external stakeholders.
- Strong analytical, problem-solving, and decision-making skills.
- Demonstrated alignment with Martin’s Point Health Care values.
Preferred
- Experience with Medicare Advantage, TRICARE, or other government-sponsored programs.
- Experience with STARS, RAF, risk adjustment, Medicare bids, HEDIS, or value-based care arrangements.
- Prior management or physician leadership experience.
- Experience supporting medical policy, payment policy, pharmacy, or clinical program development.
- Experience building relationships with network physicians, hospitals, and community providers.
This position is not eligible for immigration sponsorship.
We are an equal opportunity/affirmative action employer.
Martin's Point complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact
Do you have a question about careers at Martin’s Point Health Care? Contact us at:
Originally posted on Himalayas