Medical Senior Director, Care Delivery Model and Payment Innovation

Medical Senior DirectorCare Delivery Model and Payment Innovation

Position Summary

The Medical Senior DirectorCare Delivery Model and Payment Innovationis a senior physician leadership role responsible for reimagining and scaling enterprisepopulation health programsand risk-based care strategieswhile also leading strategic external partnerships that accelerateand enableparticipation ofprovidersand patientsinalternative payment models.This role reports to the Associate Chief Medical OfficerforEnterprise Provider Experience Network & Value-Based Care.

Thispositionadvances the organizations evolution from traditional total medical cost programs to total cost of care managementacross enterprisebusiness unitsworking towards integration ofmedical pharmacy behavioral and other clinical domains into cohesivetotal cost-of-care and outcomes-drivenstrategies. The leader serves as a clinical integrator acrossAffordabilityProductProviderRelationsNetworkNetwork Strategy andData &Analyticsensuringthat care models incentives and performance management approaches are clinically sound analytically rigorous and operationally scalable.The role willdevelop andlead strategic test-and-learn initiatives that inform innovation in population health and total cost of care management.

The role partners closely withProvider&NetworkRelations (PNR) as the marketfacing execution arm aligning strategy with local provider engagement contracting and implementation to drive measurable improvements in quality affordability and experience across populations.

Key Responsibilities

EnterpriseAlternative Payment ModelStrategy Partnerships&Growth

• Identify structure and clinically guide external partnerships (e.g. provider organizations enablement platforms care delivery partners) that accelerate growth in risk participation acrosshealthcare disciplines and business units.

• Lead the redesign and modernization of existingriskbasedand alternative paymentprograms ensuring alignment with evolving market provider and regulatory dynamics.

• Shape and operationalize enterpriserisk-based payment and care deliverystrategy across markets and products.

• Partner with Network Contracting and Actuarial teams to expand the portfolio of valuebased offerings beyond total medical cost to true total cost of care management including pharmacy and other services.

• Support differentiatedriskaligned carepayment offeringsandsupport modelsas well as development ofspecialtytotal-cost-of-carepartnership strategy in conjunction with Product.

• Serve as a senior clinical voice in evaluating new market opportunities and partnership models that drive sustainablescalein riskbearing and outcomesaligned models.

CareDeliveryModel Innovation

• Drive innovation in care delivery through the design evaluation and scaling of advanced primary care and specialty carenetworks including multidisciplinary and teambased approaches.

• Support development of care models that integrate physicians pharmacists behavioral health clinicians and other members of the clinical care team to improve outcomes and total cost of care.

• Expand alternative payment models to other lines of business including international health.

• Translate clinical andutilizationinsights into targeted interventions.

• Lead pilots and testandlearn initiatives that incorporate new care delivery partnerships digital enablement and alternative network strategies with rigorous clinical and financial evaluation.

• Ensure care models align with evidence regulation provider workflows and member experience.

Population Management Capabilities Clinical Insights &ProviderEnablement

• Maintain a close ongoing partnership with the PNR team as the primary marketfacing execution arm for care delivery model and payment innovationas well asprovider engagement.

• Provide clinical leadership for Network strategies influencing design contracting approaches and performance expectations.

• Help reimagine the provider relationship expanding the definition of provider beyond physicians to include pharmacists behavioral healthand other clinical care team members within contracting and performance models.

• Guide provider- and market-level insight development on cost qualityutilization and risk.

Leadership and Team Development

• Represent the organization in strategic discussions with senior provider and system leadershipregardingnetwork participation care delivery transformation and riskbased collaboration.

• Build and mentormultidisciplinary teams.

• Drive execution through influence in a matrixed enterprise environment.

Qualifications

• MD or DO with board certification.

• 10 years of progressive clinical leadership experience.

• Deep experience inalternative payment models population health and clinical analytics.

• Proven ability to lead complex initiatives across matrixed organizations.

Preferred:

• Advanced degree (MPH MHA MBA or equivalent).

• Experience with large-scale care model design and performance evaluation.

• Background in payer provider or risk-bearing organizations.

Success Characteristics

• Demonstrated ability to build and scale valuebased care ecosystems including external partnerships advanced care models and provider enablement capabilities

• Clinically credible and analytically fluent.

• Strategic yetexecution-oriented.

• Collaborative pragmatic andoutcomes-driven.

• Passionate about transforming care throughdelivery and payment innovation