Medical director

1 week ago

Montgomery, United States Martin's Point Health Care Full time

Position: Medical Director - Health Plan, RemoteMake a Meaningful Impact on Member HealthPhysician – Utilization Management & Medical ReviewHelp shape how care is delivered—beyond the exam room.At Martin’s Point Health Care, this physician role plays a key part in ensuring members receive clinically appropriate, high-quality care while supporting responsible cost management. You’ll partner closely with the Health Plan Medical Director and contribute directly to our Triple Aim strategy.What You’ll DoPerform medical necessity reviews, including disputes and appealsParticipate in case reviews focused on quality, safety, and outcomesSupport utilization, care management, and disease management programsEnsure compliance with NCQA, CMS, and TRICARE requirementsContribute to medical policy developmentCollaborate with Informatics, Network Management, and Medical EconomicsUse data to assess network provider utilization and support improvementHelp manage and strategically deploy ACOsSupport risk adjustment activities as neededTrack and support key metrics (MLR, utilization trends, HEDIS, QI)What You BringMD or DO (will consider any specialty, prefer Family, Internal, or Emergency Med)Active, unrestricted medical license (or eligibility) in ME or NHBoard certified with direct patient care experienceHealth plan or utilization management experienceStrong clinical judgment and analytical skillsAbility to build trusted relationships across teamsAlignment with Martin’s Point values and missionWhy This RolePhysician-led, mission-driven workSystems-level impact on quality and costCollaborative, data-informed environmentOpportunity to influence care for entire populationsThis is a remote position with occasional travel to Portland, Maine.Ready to make a difference? Join us in ensuring every member receives the right care, at the right time, in the right place.Why Join Martin’s Point?Mission-driven organization focused on improving community healthStrong culture of respect, collaboration, and work-life balanceCertified “Great Place to Work” since 2015Comprehensive benefits packageExplore More:Meet Martin’s PointOur LocationsLive and Work in MaineView Martin's Point BenefitsHow to Apply:For more information or to submit your application, please contact:Shawn-Elise LapomardaEmail: We are proud to be an equal opportunity/affirmative action employer.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

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