Senior Director of Population Health

ESSENTIAL JOB DUTIES

• Develop and execute the organization's Population Health strategy, aligning initiatives with organizational goals, quality objectives, regulatory requirements, and financial performance targets

• Serve as a key clinical leader and strategic partner across departments to design and implement programs that improve health outcomes, reduce avoidable utilization, and manage total cost of care

• Lead the development and implementation of population health initiatives focused on preventive care, chronic disease management, care transitions, health equity, and member engagement

• Establish policies, procedures, and governance structures that support effective population health, medical management, and pharmacy management operations

• Monitor emerging healthcare trends, regulatory changes, and clinical best practices to ensure organizational readiness and continuous improvement

• Provide strategic oversight of Medical Management functions, including utilization management, care management, disease management, and case management programs

• Partner with Pharmacy leadership and Pharmacy Benefit Management (PBM) vendors to develop and implement pharmacy management strategies that improve clinical outcomes, promote medication adherence, and optimize pharmacy spend

• Support the development and evaluation of medical and pharmacy programs designed to improve quality, affordability, and member experience

• Ensure clinical programs are evidence-based, compliant with applicable regulations, and aligned with organizational objectives

• Lead quality improvement initiatives that improve member health outcomes and support achievement of HEDIS®, CMS, NCQA, and other quality performance measures

• Utilize population health analytics and clinical data to identify opportunities for intervention, measure outcomes, and drive continuous improvement

• Collaborate with providers and internal stakeholders to close care gaps, improve preventive care compliance, and enhance chronic condition management

• Promote health equity initiatives and address social determinants of health through targeted population health strategies

• Develop strong partnerships with providers, healthcare systems, and community organizations to support coordinated, high-quality care delivery

• Collaborate with clinical, operational, pharmacy, quality, and analytics teams to improve care coordination and member outcomes

• Support provider engagement efforts through performance reporting, education, and collaborative improvement initiatives

• Serve as a clinical resource and subject matter expert for population health and medical management programs.

• Provide leadership, coaching, and development for population health, medical management, and clinical program teams

• Establish performance goals, monitor operational effectiveness, and implement continuous improvement initiatives

• Ensure appropriate staffing, resource allocation, and workflow design to support organizational objectives

• Maintains regular and predictable attendance

• Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practice

• Works to encourage and promote Company culture throughout the organization

• Other duties as may be assigned

QUALIFICATIONS

• Master's degree in Nursing, Physician Assistant Studies, Healthcare Administration, Public Health, or related clinical field required

• Current, unrestricted licensure as an Advanced Practice Provider (Nurse Practitioner or Physician Assistant) preferred

• Additional clinical certifications or advanced healthcare leadership credentials preferred.

• 7+ years - Clinical experience required

• 5+ years - Healthcare administration, including UM experience highly preferred

• Experience in internal medicine, family medicine or emergency medicine required

• Experience in specialty areas such as oncology, rehabilitation, and physical medicine preferred

• Board Certification in a recognized specialty by the American Board of Medical Specialties or the American Board of Osteopathic Specialists

• Ability to interpret and explain complex government policies

• Knowledge of health plan operations and utilization management strategies

PHYSICAL REQUIREMENTS

Prolonged periods of sitting at a desk and working on a computer. Moderate to significant amount of stress in meeting deadlines and dealing with day-to-day responsibilities. Must be able to drive a vehicle and daytime/overnight travel as required.

BENEFITS

Accident insurance

Competitive salary

Critical Illness Insurance

Dental Insurance

Employee Assistance Program

Flexible Spending Account

Health & Wellness Program

Health Savings Account

Life & AD&D Insurance

Long Term Disability

Medical Insurance

Paid Time Off

Pet Insurance

Short Term Disability

Vision Insurance