REMOTE - Medical Director - HEALTH PLAN

Position:
Medical Director - Health Plan, Remote

Make a Meaningful Impact on Member Health

Help shape how care is deliveredbeyond the exam room.

At Martins Point Health Care, this physician role plays a key part in ensuring members receive clinically appropriate, high-quality care while supporting responsible cost management. Youll partner closely with the Health Plan Medical Director and contribute directly to our Triple Aim strategy.

• Perform medical necessity reviews, including disputes and appeals
• Participate in case reviews focused on quality, safety, and outcomes
• Support utilization, care management, and disease management programs
• Ensure compliance with NCQA, CMS, and TRICARE requirements
• Contribute to medical policy development
• Collaborate with Informatics, Network Management, and Medical Economics
• Use data to assess network provider utilization and support improvement
• Help manage and strategically deploy ACOs
• Support risk adjustment activities as needed
• Track and support key metrics (MLR, utilization trends, HEDIS, QI)

• MD or DO
• Active, unrestricted medical license (or eligibility) in ME or NH
• Board certified with direct patient care experience
• Health plan or utilization management experience
• Strong clinical judgment and analytical skills
• Ability to build trusted relationships across teams
• Alignment with Martins Point values and mission

• Physician-led, mission-driven work
• Systems-level impact on quality and cost
• Collaborative, data-informed environment
• Opportunity to influence care for entire populations

This is a remote position with occasional travel to Portland, Maine.

Ready to make a difference? Join us in ensuring every member receives the right care, at the right time, in the right place.

Why Join Martins Point?

• Mission-driven organization focused on improving community health
• Strong culture of respect, collaboration, and work-life balance
• Certified Great Place to Work since 2015
• Comprehensive benefits package

Explore More:

• Meet Martins Point
• Our Locations
• Live and Work in Maine
• View Martin's Point Benefits

How to Apply:

For more information or to submit your application, please contact:

Shawn-Elise Lapomarda

Email: shawnelise.lapomarda

We are proud to be an equal opportunity/affirmative action employer. This position is not eligible for immigration sponsorship. We are an equal opportunity/affirmative action employer.

Martin's Point complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact job inquiries