Regional Medical Director- (Nashville,TN)

CareAllies•Nashville, TN

1d•Remote

About The Position

This position is responsible for assigned aspects of medical policies and programs. Performs medical reviews and interacts with the provider communities for assigned areas. Provides advanced clinical leadership across medical management programs, integrating traditional utilization review with strategic population health, value-based care, and provider-performance initiatives. Aligns medical policy expertise with forward-leaning clinical strategy to influence quality, Stars-related performance, affordability, risk adjustment accuracy, and market-level outcomes. This position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii.

Requirements

Medical policies and programs expertise
Medical review skills
Provider community interaction skills
Clinical leadership in medical management programs
Understanding of utilization review, population health, value-based care, and provider-performance initiatives
Ability to align medical policy with clinical strategy
Focus on quality, Stars-related performance, affordability, risk adjustment accuracy, and market-level outcomes

Responsibilities

Responsible for assigned aspects of medical policies and programs.
Performs medical reviews and interacts with the provider communities for assigned areas.
Provides advanced clinical leadership across medical management programs, integrating traditional utilization review with strategic population health, value-based care, and provider-performance initiatives.
Aligns medical policy expertise with forward-leaning clinical strategy to influence quality, Stars-related performance, affordability, risk adjustment accuracy, and market-level outcomes.