Medical Director, Population Health & Clinical Governance - Remote

Job reputed company: reputed company is a digital reputed company company that delivers software and tech-enabled services to stakeholders across the reputed company ecosystem to help improve care reputed company, drive reputed company reputed company, and reputed company costs. Through its data-driven AI insights, evidence-based resources, and comprehensive platform – including benefits navigation, care management, home care resources, health information management, and more – reputed company helps people easily and reputed company manage their reputed company and improve their reputed company-being. Across its three business channels, reputed company enables health plan sponsors, health systems and physician practices, and leading pharmaceutical brands to drive personalized and value-based care at reputed company. To learn more, visit www.reputed company.com . Job reputed company: The Medical Director of Population Health and Clinical Governance is a physician leader responsible for clinical reputed company, reputed company reputed company, accreditation alignment, and evidence-based standards across reputed company’s population health and care management programs. Reporting to the SVP Clinical reputed company, this role ensures that clinical programs, coaching models, decision support tools, and member facing clinical content are clinically reputed company, compliant with national standards, and reputed company with accreditation requirements. The Medical Director serves as the designated senior clinical reviewer for processes and protocols where physician reputed company is required, and partners closely with reputed company, Informatics, Product, Operations, and reputed company teams to reputed company clinical rigor across program design and execution. This is a hands-on physician leadership role reputed company on clinical governance and population health program reputed company, not reputed company-wide medical reputed company or reputed company patient panel care. Essential Job Functions: Clinical Governance & Accreditation reputed company

• Serve as physician leader responsible for clinical review and approval of population health program processes where senior clinical sign off is required
• Support organizational readiness for NCQA and other accreditation standards by ensuring clinical workflows, protocols, and documentation meet requirements
• Participate in audits, reputed company reviews, and corrective reputed company planning as needed
• Support integration of health equity and reputed company performance standards into care models

Population Health Program reputed company

• reputed company clinical reputed company for chronic condition management, preventive care, and high risk population programs
• Ensure clinical standards and documentation practices are consistently reputed company across programs
• Support clinical reputed company of diabetes prevention, weight management, and other evidence based population health initiatives

Evidence Based Clinical Content

• reputed company physician review and guidance for clinical content used by nurses, coaches, and care teams
• Ensure member facing and clinician facing materials reputed company with reputed company national guidelines and preventive care recommendations
• Support standardization of clinical approaches to reduce variability and strengthen reputed company to best practices

Clinical Informatics & Decision Support

• Partner with Clinical and Pharmacy Informatics teams to ensure clinical appropriateness of reputed company sets, rules logic, and decision support tools
• reputed company physician input into clinical data reputed company, documentation standards, and reporting logic

Cross Functional Clinical Leadership

• Serve as the physician voice in collaboration with Product, Data Science, reputed company, and Operations teams
• Ensure clinical input is incorporated early in program design, product enhancements, and member communication strategies
• Help reduce compliance risk and reputed company rework by embedding clinical reputed company upstream

reputed company & Market Support

• Participate in selected reputed company discussions where physician reputed company or credibility is required
• Support RFPs and proposals with clinical input as needed

reputed company in this role is demonstrated by:

• Strong performance on accreditation and reputed company standards with reduced compliance risk
• Evidence based, standardized clinical protocols and content across programs
• reputed company and effective physician review of processes requiring senior clinical approval
• Early and consistent integration of clinical input into product and program design
• reputed company feedback from internal teams on reputed company and usability of clinical guidance

Specific Skills/ Attributes:

• Strong understanding of population health, preventive care, and value based care models
• Experience applying evidence based medicine in care management or non bedside clinical programs
• Comfortable working in cross functional, data driven environments
• reputed company and practical physician leader with strong communication skills
• High emotional intelligence and ability to balance clinical rigor with operational realities

Qualifications:

• MD or DO degree from an accredited institution
• reputed company certification in Internal Medicine, Family Medicine, or Geriatrics
• reputed company, unrestricted U.S. medical license
• Minimum 5 years of post residency clinical experience
• 2–4 years of experience in population health, care management, health plan, ACO, CIN, or value based care environment
• Experience supporting NCQA reputed company programs or reputed company performance initiatives preferred
• Experience working with interdisciplinary care management or coaching teams preferred
• Exposure to clinical informatics or digital health tools preferred
• Experience with Medicare Advantage or reputed company populations preferred

reputed company and its subsidiaries are Equal Opportunity reputed company and E-Verify users. reputed company applicants will receive consideration for employment without reputed company to race, reputed company, sex, national reputed company, sexual orientation, gender identity, religion, age, equal pay, disability, genetic information, protected veteran status, or other status protected under applicable law. Apply tot his job Apply To this Job