REMOTE - Medical Director - HEALTH PLAN

Position: Medical Director - Health Plan, Remote

Make a Meaningful Impact on Member Health

Physician – Utilization Management & Medical Review

Help shape how care is delivered—beyond the exam room.

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

What You’ll 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 Martin’s 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 Martin’s 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 Martin’s 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@martinspoint.org

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 jobinquiries@martinspoint.org

Martin's Point Health Care is an innovative not-for-profit health care organization offering high-quality, affordable health care and coverage to the people of Maine and throughout New England.

We have seven health care centers in Maine and New Hampshire offering primary and specialty care to those with most major health insurance plans. Our collaborative, team based approach has created an environment where each patient is treated with warmth, care and concern.

Martin's Point also administers two health insurance plans: Generations Advantage--with the only 5-Star Medicare Advantage plans in New England, and the US Family Health Plan for active duty military families and retirees throughout most of northern New England and New York.

We believe that understanding both the clinical and health plan administrative side gives us the insight we need to make meaningful improvements to the health care system. Martin's Point is dedicated to creating a community of healthy people through authentic relationships and trust.

Talk to us and find out the many reasons why Great Place to Work® and Fortune magazine have named Martin’s Point Health Care one of the 2018 Best Workplaces in Health Care!

Martin’s Point Health Care is an Equal Opportunity Employer.