Senior Medical Director

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Reporting to the Chief Medical Officer (CMO), the Senior Medical Director provides strategic clinical leadership and oversight for SFHP's Medical Directors and Quality Review teams. You will be the physician lead for the Utilization Management (UM) Committee and UM Delegation Oversight, ensuring that clinical decision-making, program integrity, and compliance with regulatory standards are maintained across all delegated entities. You will promote initiatives that improve quality of care, operational efficiency, and member outcomes.

You will lead Medical Directors and clinical staff, oversee the resolution of Potential Quality Issues (PQIs), clinical grievances and appeals, and foster collaboration across Health Services and the Quality & Population Health Management department to strengthen systemwide quality performance and accountability.

Please note that while SFHP supports a hybrid work environment, you are required to be onsite and in-office a minimum of 4 days per month. This is a hybrid position, based in our Downtown San Francisco office.

Salary: $330,000 to $370,000 annual

• Provide strategic leadership and clinical oversight to the Medical Directors and Quality Review teams.
• Be the physician lead for the UM Committee and UM Delegation Oversight, ensuring consistent application of clinical criteria, regulatory compliance, and appropriate medical necessity determinations.
• Oversee the identification, evaluation, and resolution of PQIs, grievances and appeals.
• Partner with the Quality & Population Health Management department to support quality performance initiatives (e.g., HEDIS, CAHPS) and ensure coordination between clinical quality, utilization, and population health strategies.
• Develop and implement frameworks for accountability, measurement, and reporting across the Medical Director and Quality Review teams.
• Develop Medical Directors to strengthen leadership, collaboration, and professional growth.
• Collaborate with internal partners (e.g., Provider Relations, Claims, Pharmacy, and Population Health) to enhance clinical integration, compliance, and provider network performance.
• Participate as a physician leader on SFHP committees, including Utilization Management, Grievance Review, Quality Improvement, and Pharmacy & Therapeutics.
• Provide physician leadership to NCQA accreditation-related activities and ensure adherence to all applicable state, federal, and contractual requirements.
• Promote data-driven decision-making; evaluate clinical interventions for impact, scalability, and sustainability.

• MD or DO degree from an accredited institution, with an active, unrestricted California medical license.
• Board certification in a recognized specialty required; primary care (Internal Medicine or Family Practice) preferred.
• Minimum of 5 years post-residency experience in a recognized medical specialty, including at least 3 years in managed care or health plan leadership.
• 3 or more years of leadership/management experience required.
• Expertise leading Medical Directors and cross-functional teams in a managed care of health system environment.
• Expertise in UM Committee, UM Delegation Oversight, and Quality Review functions.
• Experience applying clinical practice guidelines, evidence-based criteria, and regulatory standards in decision-making.
• Expertise in CMS, DHCS, Medi-Cal and Medicare regulations; experience with NCQA accreditation preferred.
• Medical Director for an IPA, medical group or HMO highly desirable.
• Experience applying data analytics and performance metrics to improve quality and operational decisions.

• Medical:
  You'll have a choice of medical plans, including options from Kaiser and Blue Shield of California, heavily subsidized by SFHP.
• Dental:
  You'll have a choice of a basic dental plan or an enhanced dental plan which includes orthodontic coverage.
• Vision:
  Employee vision care coverage is available through Vision Service Plan (VSP).
• Retirement…