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Job description
Job Summary
This position is responsible for assigned aspects of medical policies and programs. Performs medical reviews and interacts with the provider communities for assigned areas. Provides advanced clinical leadership across medical management programs, integrating traditional utilization review with strategic population health, value-based care, and provider-performance initiatives. Aligns medical policy expertise with forward-leaning clinical strategy to influence quality, Stars-related performance, affordability, risk adjustment accuracy, and market-level outcomes.
Required Job Qualifications
Physician with a current and unrestricted physician license in a state or territory of the United States.
Maintain Board Certification as a M.D. or D.O. (by a specialty board approved by the American Board of Medical Specialties (doctors of medicine); or the Advisory Board of Osteopathic Specialists (doctors of osteopathic medicine)
5 years of clinical experience
Analytical and communication skills
Strategic thinking skills
Preferred Job Qualifications
Ability to travel 3 years
Managed Care experience with IPA (independent Physician Association), MSO or Value Based Enablement Organization Experience
Advanced skills in clinical interpretation, communication, data-driven strategy, and collaborative leadership
Experience with Stars performance, risk adjustment education, or provider engagement
Experience in matrixed environments and cross-functional clinical leadership
EEO Statement
We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
Benefits & Compensation
From health and wellness benefits, 401(k) savings plan, pension plan, a minimum of 15 days’ of paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives.
The salary offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. Min to Max Range: $191,500.00 - $355,600.00. Exact compensation may vary based on skills, experience, and location.
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Worksite address
baltimore, MD, 21276, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.