Full-Time
Director Clinical Programs
Health Plan
Posted on 9/19/2025
Martin's Point Health Care
501-1,000 employees
Not-for-profit health care organization
No salary listed
No H1B Sponsorship
Portland, ME, USA
Hybrid
This role requires occasional travel to Portland, Maine.
 Medical, Clinical & Veterinary (2) |
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- RN, NP, PA, PharmD, or similar clinical licensure.
- 5+ years’ experience in managed care, utilization/care management, and program development.
- Strong project management and data-driven decision-making skills.
- Knowledge of Medicare Advantage required; TRICARE experience a plus.
- Lead strategy, design, and execution of innovative clinical programs.
- Oversee utilization review operations and ensure care aligns with evidence-based guidelines.
- Drive performance, quality, and outcomes that meet the Triple Aim—better care, better health, and lower cost.
- Partner across departments and with external vendors to improve population health outcomes.
- Mentor and develop a high-performing clinical team.
Martin's Point Health Care is a not-for-profit health care organization that provides medical services to individuals and families. Its offerings include a range of primary and specialty care delivered through clinics and care teams, with a focus on coordinated, accessible patient care and preventive services. The company reinvests profits back into the organization to improve care, expand community benefits, and keep services affordable. Unlike for-profit competitors, it emphasizes community health impact and long-term patient relationships, supported by a mission-driven, member- or patient-centered approach. The goal is to improve the health of the communities it serves by delivering high-quality, affordable care and reinvesting earnings to enhance services and access.
Company Size
501-1,000
Company Stage
N/A
Total Funding
N/A
Headquarters
Portland, Oregon
Founded
1981
Simplify's Take
What believers are saying
- Avoided litigation costs and uncertainty through July 2023 DOJ settlement.
- Whistleblower award of $3.82M incentivizes internal compliance reporting.
- DOJ settlement deters competitors from similar Medicare Advantage upcoding practices.
What critics are saying
- DOJ launches post-2019 False Claims Act probes using Wilbur precedent within 6-12 months.
- CMS 2024 model cuts reimbursements by validating fewer diagnosis codes in 3-6 months.
- New whistleblowers sue over DxID vendor HCC additions, penalties exceed $22M in 12-18 months.
What makes Martin's Point Health Care unique
- Martin's Point operates Medicare Advantage plans in Maine and New Hampshire.
- Settled $22.48M DOJ False Claims Act case in July 2023 without admitting liability.
- Whistleblower Alicia Wilbur filed qui tam suit in 2018 exposing risk adjustment issues.
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Benefits
Professional Development Budget
Company News
PORTLAND, Maine, July 31, 2023 /PRNewswire/ -- Today, Martin's Point Health Care announced that it has agreed to a settlement with the U.S. Department of Justice (DOJ) to resolve an investigation related to Martin's Point's Risk Adjustment practices for the payment years 2016-2019. The claims resolved by the settlement are allegations only, and there has been no determination of liability. The settlement is not related to member care or the payment of member claims.Martin's Point worked collaboratively with the DOJ during the course of the investigation. Despite denying liability for the litigation claims at issue, Martin's Point ultimately determined that settlement of this matter was appropriate rather than engaging in the cost and uncertainty of protracted litigation.A spokesperson for the organization commented: "This settlement is not an admission of liability, it instead allows us to avoid the disruption, expense, and uncertainty of litigation. It is important to note that this investigation is unrelated to member care or payment of member claims