JOB PURPOSE

The Senior Director of Population Health provides strategic and operational leadership for the organization's Population Health programs, including Medical Management, Pharmacy Management, Care Management, Care Coordination, Utilization Management, and Quality Improvement initiatives. This role is responsible for developing and executing population health strategies that improve clinical outcomes, enhance member experience, achieve quality and regulatory goals, and effectively manage total cost of care.

Serving as a key clinical leader, the Senior Director collaborates across provider, pharmacy, operational, financial, and executive teams to implement evidence-based programs that address the health needs of members while supporting organizational performance and growth. The role translates clinical best practices, regulatory requirements, and population health analytics into scalable programs that drive measurable improvements in quality, utilization, and health outcomes.

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

401K (4% Match, Immediate Vesting)

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

PRE-EMPLOYMENT SCREENING

Drug Screen and Background Check Required