Medical Senior Director, Care Delivery Model and Innovation

Position Summary

The Medical Senior Director, Care Delivery Model and Payment Innovation, is a senior physician leadership role responsible for reimagining and scaling enterprise population health programs and risk-based care strategies, while also leading strategic external partnerships that accelerate participation of providers and patients in advanced alternative payment models within primary and specialty care. This role reports to the Associate Chief Medical Officer for Value-Based Care, Trend, and Provider and Network Relations.

This position advances the organization’s evolution from traditional total medical cost programs to total cost of care management across the enterprise—working towards integration of medical, pharmacy, behavioral, and other clinical domains into cohesive total cost-of-care and outcomes-driven strategies. The leader serves as a clinical integrator across Affordability, Product, Provider Relations, Network, Network Strategy, and Data & Analytics—ensuring that care models, incentives, and performance management approaches are clinically sound, analytically rigorous, and operationally scalable.

The role will lead strategic test-and-learn initiatives that inform innovation in population health and total cost of care management. The role partners closely with Provider & Network Relations (PNR) as the market‑facing execution arm, aligning strategy with local provider engagement, contracting, and implementation to drive measurable improvements in quality, affordability, and experience across populations.

• Lead the re‑design and modernization of existing risk‑based and alternative payment programs, ensuring alignment with evolving market, provider, and regulatory dynamics.
• Identify, structure, and clinically guide external partnerships (e.g., provider organizations, enablement platforms, care delivery partners) that accelerate growth in two‑sided risk participation across primary and specialty care.
• Shape and operationalize enterprise risk-based payment and care delivery strategy across markets and products.
• Partner with Network, Contracting, and Actuarial teams to expand the portfolio of value‑based offerings beyond total medical cost to true total cost of care management, including pharmacy and other clinical services.
• Support differentiated risk‑aligned care and payment offerings and support models.
• Serve as a senior clinical voice in evaluating new market opportunities and partnership models that drive sustainable scale in risk‑bearing and outcomes‑aligned models.

• Drive innovation in care delivery through the design, evaluation, and scaling of advanced primary care and specialty care models, including multidisciplinary and team‑based approaches.
• Support development of care models that integrate physicians, pharmacists, behavioral health clinicians, and other members of the clinical care team to improve outcomes and total cost of care.
• Expand alternative payment models to other lines of business, including international health.
• Translate clinical and utilization insights into targeted interventions.
• Lead pilots and test‑and‑learn initiatives that incorporate new care delivery partnerships, digital enablement, and alternative network strategies, with rigorous clinical and financial evaluation.
• Ensure care models align with evidence, regulation, provider workflows, and member experience.

• Maintain a close, ongoing partnership with the PNR team as the primary market‑facing execution arm for care delivery model and payment innovation as well as provider engagement.
• Provide clinical leadership for Network strategies, influencing design, contracting approaches, and performance expectations.
• Help reimagine the provider relationship, expanding the definition of “provider” beyond physicians to include pharmacists and other clinical care team members within contracting and performance models.
• Guide provider- and market-level insight development on cost, quality, utilization, and risk.

• Represe…