Health Plan Medical Director

Mass General Brigham Health Plan Holding Company, Inc.

Boston, MA, US
Base: $285,000.00 to $325,000.00 annually; bonus/e...
Fully remote
Active massachusetts physician license
3-5 years health plan experience
Utilization management expertise
This role leads as a senior physician providing medical management leadership for clinical services operations within Mass General Brigham Health Plan

Job Summary

  • This role leads as a senior physician providing medical management leadership for clinical services operations within Mass General Brigham Health Plan.
  • The position requires expertise in utilization management, health plan quality, accreditation, and care management to ensure cost efficiency and high-quality care.
  • Candidates will collaborate with the CMO and various teams to develop clinical programs, handle appeals, and oversee disease management initiatives.

Matching Summary

This role leads as a senior physician providing medical management leadership for clinical services operations within Mass General Brigham Health Plan.

Salary

Base: $285,000.00 to $325,000.00 annually; Bonus/Equity: Not specified; Benefits: Comprehensive benefits package including flexible work options and career growth opportunities

Skills & Requirements

Must-have

  • Active Massachusetts physician license
  • 3-5 years health plan experience
  • Utilization management expertise
  • Peer to peer discussion skills
  • Quality and accreditation knowledge

Nice-to-have

  • Experience with MassHealth and Medicare compliance
  • Strong collaboration with business development teams
  • Ability to represent organization at external forums
  • Commitment to patient-first organizational culture

Key Requirements

  • Full active Massachusetts physician license
  • 3-5 years of Health Plan experience
  • Prior experience in utilization management
  • Experience with peer to peer discussions
  • Knowledge of NCQA and Division of Insurance compliance

Work Rights

Not specified

Tailored Resume

Cover Letter