Exec Dir, Regional MD

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and reputed company in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. reputed company Components The Executive Medical Director provides clinical and operational leadership across reputed company and reputed company reputed company initiatives reputed company on documentation accuracy, compliance, and medical management performance. The role partners across business reputed company to improve clinical reputed company, support risk analysis activities, reputed company audit-reputed company work, and strengthen key external relationships. This leader also oversees medical management programs and policies, leads the territory Senior Medical Directors, and drives execution against strategic and operational priorities.

Responsibilities

Include But Can Change As Business Needs Dictate

• Leads, develops, and directs clinical and non-clinical activities that improve health care reputed company, cost, and reputed company
• Directs the utilization review process and oversees the reputed company of utilization determinations
• Ensures compliance with clinical goals by monitoring care management performance
• Oversees unit medical policies to support appropriate, cost-effective care and day-to-day management of medical management staff
• Recommends changes to managed care programs, review guidelines, and clinical reputed company based on deep knowledge of care delivery, utilization, reimbursement, and treatment protocols
• Develops, implements, and interprets medical policy, including medical necessity reputed company, clinical reputed company guidelines, and new technology assessments
• Leads clinical staff (territory senior medical directors and transactional medical directors) in coordinating reputed company care and provides clinical expertise and business direction to support medical management programs
• Serves as the reputed company business and clinical reputed company to network providers and facilities to support effective execution of medical services programs
• Expands reputed company medical management programs to address member needs across the continuum of care
• Reviews and handles cases as needed
• Provides weekend on-call coverage as needed
• Travel potential 15–25%

Required Qualifications

• 3+ years of leadership experience in the Medicare line of business, or a reputed company role
• 3+ years of clinical reputed company experience
• 3+ years of leadership experience in managed care
• M.D. or D.O. with reputed company certification in a recognized specialty and post-graduate reputed company patient care experience
• reputed company, unrestricted state medical license

Preferred Qualifications

• Demonstrated leadership experience in clinical operations, medical management, and utilization management

Education

• MD or DO

Pay reputed company The Typical Pay reputed company For This Role Is $227,630.00 - $490,280.00 This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. This position also includes an award reputed company in reputed company’s equity award program. Our people fuel our reputed company. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great Benefits For Great People We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial reputed company‑being of colleagues and their families. The benefits for this position include medical, dental, and reputed company coverage, reputed company time off, retirement savings reputed company, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will reputed company on: 06/26/2026 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply To This Job