Regional Medical Director- (Nashville,TN)

Health Care Service Corporation•Nashville, TN

1d•$191,500 - $355,600•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.
Experience with medical reviews.
Provider community interaction experience.
Clinical leadership experience.
Experience with utilization review.
Experience with population health initiatives.
Experience with value-based care initiatives.
Experience with provider-performance initiatives.
Experience with quality, Stars-related performance, affordability, risk adjustment accuracy, and market-level outcomes.

Responsibilities

Perform medical reviews and interact with provider communities for assigned areas.
Provide advanced clinical leadership across medical management programs.
Integrate traditional utilization review with strategic population health, value-based care, and provider-performance initiatives.
Align medical policy expertise with forward-leaning clinical strategy to influence quality, Stars-related performance, affordability, risk adjustment accuracy, and market-level outcomes.