Executive Medical Director, Value-Based Care

• Serve as primary clinical leader for relationships with advanced primary care, value-based specialty care, and complex care providers
• Lead assigned senior clinical specialists
• Partner with Network value-based contracting, analytics, and actuarial teams to evaluate total cost of care, quality, and experience performance
• Shape engagement strategy with advanced primary care, value-based specialty care, and complex care providers
• Determine where to expand or contract provider relationships
• Take accountability for provider-group performance on cost, quality, and experience, including MA Stars measures
• Collaborate as part of the Medical Affairs Network leadership team to improve provider performance across all lines of business
• Ensure timely execution of deliverables according to due dates and Federal/state regulatory requirements
• Partner with providers clinically to support their success on behalf of members

Requirements

• MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine)
• Active and current medical license (MD or DO) without encumbrances
• Board Certification including Maintenance of Certification in an American Board of Medical Specialties specialty
• 5-10 years of work experience in managed care, value-based care, and quality
• 5 years of work experience in value-based care delivery
• Ability to work effectively in a highly matrixed organization/environment
• Ability to engage physicians, vendors, community partners, administrative leaders, clinical leaders, and staff
• Ability to manage multiple priorities and adapt to change
• Ability to work virtually with occasional travel for in-person meetings
• MBA or MPH preferred
• Medical informatics and/or data science experience preferred

Core Competencies

Demonstrates expertise in clinical leadership, value-based care delivery, and managed care, with a strong focus on provider performance and regulatory compliance. Capable of engaging diverse stakeholders and managing complex relationships to enhance quality and cost-effectiveness in healthcare.

Highest-signal resume keywords

• MD Or DO
• Board Certification
• Value-Based Care Delivery
• Managed Care Experience
• Medical Informatics

ATS Optimization Keywords

Hard Skills

• Clinical Leadership
• Cost Evaluation
• Quality Performance Analysis
• Engagement Strategy Development
• Provider Relationship Management

Soft Skills

• Effective Communication
• Adaptability
• Collaboration
• Priority Management

Certifications & Qualifications

• Active Medical License
• Board Certification

Industry Keywords

• Value-Based Specialty Care
• Complex Care Providers
• MA Stars Measures
• Federal Regulatory Requirements
• Matrixed Organization

Tools & Technologies

• Data Science
• Medical Informatics