REMOTE - Vice President Medical Director of Clinical Programs

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.

Position Summary

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The Vice President, Medical Director, Health Plan provides senior clinical leadership across the Health Plan, with a focus on quality, affordability, compliance, clinical performance, and member outcomes. This role requires strong health plan experience, the ability to lead across functions, and the communication skills to influence clinical, operational, financial, regulatory, and executive stakeholders.Job Description -------------------

Employees are expected to support and demonstrate the mission, vision, and core values of Martin’s Point Health Care.

Key responsibilities include

• Partner with Health Plan senior leadership to advance clinical outcomes, affordability goals, growth targets, and overall health plan strategy.
• Provide clinical leadership across utilization management, care management, population health, quality, pharmacy, medical policy, payment policy, and clinical program development.
• Lead cross-functional collaboration among Medical Directors, Medical Economics, Quality, Network, Compliance, Pharmacy, Operations, and Clinical Programs.
• Support compliance with government program requirements, including clinical appeals and grievances, using sound clinical evidence and medical judgment.
• Use clinical, quality, utilization, and financia