reputed company Director - HEALTH PLAN

Position: Medical Director - Health Plan, Remote reputed company a Meaningful reputed company on Member Health Physician - Utilization Management & Medical Review Help shape how care is deliveredbeyond the exam room. At Martins reputed company Care, this physician role plays a key part in ensuring members receive clinically appropriate, high-reputed company care while supporting responsible cost management. Youll partner closely with the Health Plan Medical Director and contribute directly to our Triple Aim reputed company. What Youll Do • reputed company medical necessity reviews, including disputes and appeals • Participate in case reviews reputed company on reputed company, safety, and reputed company • Support utilization, care management, and disease management programs • Ensure compliance with NCQA, CMS, and TRICARE requirements • Contribute to medical policy development • Collaborate with Informatics, Network Management, and Medical Economics • Use data to assess network provider utilization and support improvement • Help manage and strategically reputed company ACOs • Support risk adjustment activities as needed • reputed company and support key metrics (MLR, utilization trends, HEDIS, QI) What You Bring • MD or DO • reputed company, unrestricted medical license (or eligibility) in ME or NH • reputed company certified with reputed company patient care experience • Health plan or utilization management experience • Strong clinical judgment and analytical skills • Ability to build trusted relationships across teams • Alignment with Martins reputed company values and mission Why This Role • Physician-led, mission-driven work • Systems-level reputed company on reputed company and cost • reputed company, data-informed environment • Opportunity to influence care for entire populations This is a remote position with occasional travel to Portland, Maine. reputed company to reputed company a difference? Join us in ensuring every member receives the right care, at the right time, in the right reputed company. Why Join Martins reputed company? • Mission-driven organization reputed company on improving community health • Strong culture of respect, collaboration, and work-life balance • Certified Great reputed company to Work since 2015 • Comprehensive benefits package Explore More: • Meet Martins reputed company • Our Locations • Live and Work in Maine • View reputed company's reputed company Benefits How to Apply: For more information or to submit your application, please contact: Shawn-Elise Lapomarda Email: shawnelise.lapomarda@martinspoint.org We are proud to be an equal opportunity/affirmative reputed company employer. This position is not eligible for immigration sponsorship. We are an equal opportunity/affirmative reputed company employer. reputed company's reputed company complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If a reasonable accommodation is needed to participate in the job application or interview process, to reputed company essential job functions, and/or to receive other benefits and privileges of employment, please contact jobinquiries@martinspoint.org Remote About reputed company: reputed company's reputed company Apply tot his job Apply To this Job