Medical Director – Population Health, Clinical Oversight

Responsibilities

Provide physician leadership for population health priorities, with a focus on high-risk and high-cost populations across lines of business. Ensure the clinical appropriateness of risk stratification and intervention approaches, informing where and how resources are deployed. Guide clinical priorities that improve outcomes, experience, and value across targeted populations, aligned to client and contractual goals. Provide physician oversight for high-cost claimants and stop-loss reporting where required for contractual, audit, or customer needs. Ensure clinical validity, accuracy, and consistency of external reporting and client deliverables. Partner with analytics teams to streamline and standardize reporting processes, reducing manual physician involvement over time while maintaining clinical integrity. Serve as the physician escalation point for complex, high-risk, or clinically ambiguous cases where physician input drives meaningful decisions or risk mitigation. Define and refine criteria for physician involvement so effort is focused on high-impact scenarios rather than broad retrospective review. Promote standards of practice, quality oversight, and exception-based engagement models that emphasize proactive, value-added physician review. Identify and eliminate low-value physician work through automation, delegation, and clearer protocols, in partnership with operations and product teams. Lead the transition from legacy case management support toward a focused, high-impact physician role concentrated on population health, governance, and critical escalations.

Requirements

Education: Doctor of Medicine (MD) or Doctor of Osteopathy (DO) degree; current, unrestricted medical license in good standing. Board certification in an applicable specialty (e.g., Internal Medicine, Family Medicine, Emergency Medicine, or relevant subspecialty) required. 7+ years of clinical practice experience, with at least 3–5 years in a health plan, population health, accountable care, or value-based care setting. Demonstrated experience with population health management, high-cost claimant oversight, or utilization management programs. Prior leadership experience in a medical director or equivalent physician leadership role strongly preferred. Deep understanding of population health concepts, including risk stratification, targeted interventions, and measurement of clinical and financial outcomes across populations. Familiarity with high-cost claimants, stop-loss programs, and clinical risk management, including how clinical oversight influences contractual performance and client satisfaction. Experience in clinical governance and quality oversight, including setting clinical standards, review criteria, and escalation pathways for complex cases. Comfort working with analytics, reporting outputs, and data-driven decision-making in a clinical or operational context.

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