Medical Director, Care & Case Management

Key Responsibilities:

Clinical and Operational Leadership:

• Serve as the clinical escalation point for care, case, and utilization management programs.

• Set and maintain clinical standards, evidence-based care pathways, and clinical quality expectations across the portfolio, using clinical judgment in collaboration with subject matter experts.

• Own clinical KPIs, including setting targets, evaluating performance gaps, and redesigning workflows to close them.

• Interrogate the data. Identify outliers or workflows that don't make sense, and drive them to resolution and improvement.

• Run the program's operating cadence, including weekly performance reviews, escalation triage, and action tracking, to the team accountable to committed targets and timelines.

Program Design and Strategy:

• Evolve the clinical operating model across adult, maternity, and pediatric populations to deliver on Included Health’s population health strategy.

• Partner with Product and Engineering to design, validate, and deploy AI and agentic tools into clinical workflows, and ensure AI-generated output is valid and actionable.

• Build new programs and models of care, and define how they scale across populations and clients.

People Management:

• Lead, manage, and develop leaders, setting clear clinical and operational expectations.

• Conduct performance reviews, coaching, and feedback for direct reports.

• Attract and retain a strong, diverse pool of clinicians and talent aligned with company vision and goals.

Cross-functional Collaboration:

• Partner with other clinical leaders and cross-functional stakeholders to coordinate care for members with multi-specialty needs.

• Represent care management in cross-functional initiatives, pilots, and strategic planning related to complex care.

• In partnership with the Quality team, implement quality assurance processes to ensure consistent, excellent service to members.

Qualifications:

Required:

• Education: Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO).

• Clinical Experience: Board certified in internal medicine, family medicine, med-peds, or a related specialty, with a minimum of 7 years of post-residency clinical experience, and the ability to apply that clinical lens to population health leadership.

• Leadership Experience: Minimum of 5 years in a healthcare leadership role with direct oversight of clinical teams or programs, including experience managing other clinical leaders (managing managers).

• Licensure: Active, unrestricted medical license in good standing in state of residence, plus active multi-state licensure or willingness to obtain it.

• Operations and Performance: Track record of delivering against operational KPIs, like productivity, clinical quality, engagement, in a scaled, performance-driven setting.

Preferred:

• Digital Health: Experience working in digital health or virtual care delivery models.

• Clinical AI: Comfort integrating clinical AI tools into day-to-day workflows and care delivery.

• Population Health: Knowledge of the medical, behavioral, and social factors that drive poor outcomes and avoidable cost across complex populations.

• Location: Lives in a physician compact-eligible state.