Role overview
The Medical Director, Care Management leads the care, case, and utilization management programs, setting clinical direction and owning program performance for Included Health's CCM and UM programs.
This physician leader is first a strong operator. The person owns outcomes, not just clinical standards, with success defined as the program hitting its performance and quality targets. This role owns a critical program that bends the cost curve: navigating members to high-quality care, educating members about their health, and supporting them during vulnerable moments.
Reporting to the Senior Medical Director, Complex Care, they bring a strong, evidence-based point of view, are comfortable operating under ambiguity, and translate organizational priorities into clinical operations that perform at scale. They are responsible for ensuring the programs contribute to clinical outcomes, client commitments, and third-party oversight. This physician leader leads an innovative, fast-moving team at the core of Included Health’s population health strategy.
Serve as the clinical escalation point for care, case, and utilization management programs.
Set and maintain clinical standards, evidence-based care pathways, and clinical quality expectations across the portfolio, using clinical judgment in collaboration with subject matter experts.
Own clinical KPIs, including setting targets, evaluating performance gaps, and redesigning workflows to close them.
Interrogate the data. Identify outliers or workflows that don't make sense, and drive them to resolution and improvement.
Run the program's operating cadence, including weekly performance reviews, escalation triage, and action tracking, to the team accountable to committed targets and timelines.
Evolve the clinical operating model across adult, maternity, and pediatric populations to deliver on Included Health’s population health strategy.
Partner with Product and Engineering to design, validate, and deploy AI and agentic tools into clinical workflows, and ensure AI-generated output is valid and actionable.
Build new programs and models of care, and define how they scale across populations and clients.
Lead, manage, and develop leaders, setting clear clinical and operational expectations.
Conduct performance reviews, coaching, and feedback for direct reports.
Attract and retain a strong, diverse pool of clinicians and talent aligned with company vision and goals.
Partner with other clinical leaders and cross-functional stakeholders to coordinate care for members with multi-specialty needs.
Represent care management in cross-functional initiatives, pilots, and strategic planning related to complex care.
In partnership with the Quality team, implement quality assurance processes to ensure consistent, excellent service to members.
Required:
Education: Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO).
Clinical Experience: Board certified in internal medicine, family medicine, med-peds, or a related specialty, with a minimum of 7 years of post-residency clinical experience, and the ability to apply that clinical lens to population health leadership.
Leadership Experience: Minimum of 5 years in a healthcare leadership role with direct oversight of clinical teams or programs, including experience managing other clinical leaders (managing managers).
Licensure: Active, unrestricted medical license in good standing in state of residence, plus active multi-state licensure or willingness to obtain it.
Operations and Performance: Track record of delivering against operational KPIs, like productivity, clinical quality, engagement, in a scaled, performance-driven setting.
Preferred:
Digital Health: Experience working in digital health or virtual care delivery models.
Clinical AI: Comfort integrating clinical AI tools into day-to-day workflows and care delivery.
Population Health: Knowledge of the medical, behavioral, and social factors that drive poor outcomes and avoidable cost across complex populations.
Location: Lives in a physician compact-eligible state.
The Medical Director, Care & Case Management position at Includedhealth is based in Remote. This is a remote position.
The Medical Director, Care & Case Management position at Includedhealth is a Full time role.
The Medical Director, Care & Case Management position at Includedhealth requires 7+ yrs exp.
