Medical Director - Medicare Advantage

Infosys

About The Position

The Medical Director provides clinical leadership and oversight for Medicare Advantage medical management programs, including utilization management (UM), case management (CM), appeals and grievances, quality improvement, and population health. The role partners with operational teams to promote high-quality, evidence-based care, regulatory compliance, and improved member outcomes. Responsibilities also include reviewing and resolving complex clinical cases and appeals, ensuring timely and accurate coverage determinations, and supporting initiatives that improve quality performance, member experience, and health outcomes. The posting also describes project and product leadership duties, including defining project scope, goals, and deliverables; monitoring project performance; maintaining client stakeholder relationships; managing product lifecycles and roadmaps; identifying and mitigating risks; developing estimates and resource plans; managing project resources and change requests; contributing to client proposals; and conducting team member performance appraisals. The position may require relocation and/or travel to the work or project location. Infosys welcomes applicants authorized to work for any U.S. employer and is unable to provide immigration sponsorship for this role.

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.
Experience in post-residency clinical practice.
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.
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.
Authorization to work for any employer in the United States without employer-based visa sponsorship.

Nice To Haves

Experience with Stars, HEDIS, population health, and quality improvement initiatives.
Ability to lead multidisciplinary teams and collaborate across departments.
Excellent communication and provider engagement skills.
Strong analytical and problem-solving abilities.

Responsibilities

Provide clinical leadership for Medicare Advantage medical management programs.
Oversee utilization management activities, review and resolve complex clinical cases and appeals, and 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.
Define project scope, goals, and deliverables in collaboration with internal and client stakeholders.
Monitor project performance reports and communicate 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 roadmaps, and driving development, quality assurance, delivery, and deployment.
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 against actuals and manage personnel, technology, and budget resources.
Assist in preparing technical and commercial proposals for client engagements.
Develop resource plans and define role requirements for future project needs.
Conduct performance appraisals for team members.