Medical Director - Medicare Advantage

Infosys•Tempe, AZ

22h

About The Position

The Medical Director provides clinical leadership and oversight for Medicare Advantage utilization management, case management, appeals and grievances, quality improvement, and population health programs. The role partners with operational teams to support high-quality, evidence-based care, regulatory compliance, and improved member outcomes. The position serves as the clinical leader for Medicare Advantage medical management programs; oversees utilization management activities; reviews and resolves complex clinical cases and appeals; and ensures timely, accurate coverage determinations. It provides clinical oversight for case management and population health programs and supports and leads initiatives to improve quality performance, member experience, and health outcomes. The Medical Director also ensures compliance with Medicare Advantage regulations and accreditation standards. Infosys Healthcare focuses on AI-driven solutions to simplify healthcare complexities, build connected ecosystems, optimize operations, improve patient experiences and outcomes, and reduce costs. The posting also describes project leadership duties involving project scope, goals, deliverables, schedules, estimates, resources, risks, quality assurance, client relationships, proposals, and team performance appraisals under the assigned role of Product Project Lead 2.

Requirements

MD or DO from an accredited medical school.
Current unrestricted physician license in at least one U.S. state.
Board certification in an ABMS- or AOA-recognized specialty.
Post-residency clinical practice experience.
Experience in managed care, Medicare Advantage, utilization management, or health plan operations.
Strong clinical judgment and medical decision-making skills.
Knowledge of CMS Medicare Advantage requirements and NCQA standards.
Experience with Stars, HEDIS, Population Health, and Quality Improvement initiatives.
Bachelor’s degree or foreign equivalent from an accredited institution; three years of progressive experience in the specialty may be considered in lieu of each year of education.
Must be authorized to work for any employer in the United States without employer-based visa sponsorship; Infosys is unable to provide immigration sponsorship now or in the future.
The position may require relocation and/or travel to the work or project location.

Nice To Haves

Ability to lead multidisciplinary teams and collaborate across departments.
Excellent communication and provider engagement skills.
Strong analytical and problem-solving abilities.
Strategic mindset for delivering impactful, client-aligned projects.
Ability to manage project economics and delivery.
Strong relationships with mid- and senior-level client stakeholders.
Leadership abilities to foster team performance and growth.
Commitment to cultivating a culture of learning and innovation.

Responsibilities

Serve as the clinical leader for Medicare Advantage medical management programs.
Oversee utilization management activities and review and resolve complex clinical cases and appeals.
Ensure timely and accurate coverage determinations.
Provide clinical oversight for case management and population health programs.
Support and lead initiatives to improve quality performance, member experience, and health outcomes.
Ensure compliance with Medicare Advantage regulations and accreditation standards.
Collaborate with operational teams to support high-quality, evidence-based care and improved member outcomes.
Define project scope, goals, and deliverables in collaboration with internal and client stakeholders.
Monitor project performance reports, progress, challenges, and outcomes.
Maintain relationships with mid-level and senior client stakeholders and provide updates on sprint planning and project progress.
Manage the product lifecycle by translating business needs into technical requirements, defining the product roadmap, and driving development, quality assurance, and delivery.
Identify project risks and issues, implement mitigation strategies, and collaborate with quality assurance teams on quality planning.
Develop project estimates and manage change requests; monitor estimates versus actuals.
Oversee allocation and management of personnel, technology, and budget resources.
Assist with technical and commercial proposals for upcoming client engagements.
Develop resource plans and define role requirements to anticipate project needs and shortages.
Conduct performance appraisals for team members.