Job Description
Position: Medical Director - Health Plan, Remote
Make a Meaningful Impact on Member Health
Physician - Utilization Management & Medical Review
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.What Youll Do
- 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) What You Bring
- 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 Why This Role
- 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:
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 [email protected]
Remote
About the Company:
Martin's Point
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