Medical Director (Boston)

Title: Medical Director

Job Type: Full-time

Location: Hybrid 4 days per week in Brighton, MA office; 1 day remote from home

FLSA Status: Exempt

Position Summary

The Medical Director oversees all medical and clinical operations at BMI, Inc., ensuring the highest standards of patient care, regulatory compliance, and innovation. This role is responsible for the organization’s medical management strategy, providing clinical insight in areas such as utilization management, case management, provider network, contracting, pharmacy, and service operations (claims). The Medical Director also collaborates with stakeholders to optimize clinical effectiveness and integrate medical advancements into the organization's healthcare offerings.

Key Responsibilities

Medical Operations & Compliance

• Initiate and oversee the development and execution of an annual plan for medical management, ensuring alignment with the mission and goals of the Plan, financial resources, and government contract requirements with the Department of Defense.
• Establish and execute utilization management policies and work plans with the Plan’s key stakeholders to achieve medical management strategies.
• Establish and implement population health initiatives, including disease management programs, health risk screening, preventive health activities, and specialized case management.
• Ensure compliance with all federal, state, and regulatory requirements, including HIPAA, DHA, and Department of Defense regulations.
• Develop and implement policies to enhance patient safety, improve care quality, and integrate best clinical practices.

Leadership

• Collaborate with Provider Relations to establish, implement, and oversee education and outreach to network providers to align the Plan’s medical management objectives with clinical practice in the network.
• Participate in the Quality of Care Committee.
• Provide strategic leadership in medical policy, care coordination, and quality assurance.
• Manage and lead the clinical team.
• Partner with Human Resources to oversee hiring, training, and performance management of department employees.

Clinical Quality & Management

• Initiate and oversee the development and execution of an annual clinical quality management plan to achieve optimal health outcomes and exceptional service.
• Establish and oversee implementation within USFHP of quantitative outcome measures that meet HEDIS requirements and validate Plan performance.
• Track utilization trends and work with the Plan leadership team to identify outliers that may require focused review.
• Establish and execute utilization management policies with key stakeholders to achieve the medical management strategies for self-insured products.

Pharmacy & Cost Management

• Collaborate with the Chief Pharmacy Officer in developing policies and strategies for the cost-effective delivery of pharmacy benefits.
• Oversee medication management initiatives to improve prescription drug therapy and cost efficiency.

Stakeholder & External Relations

• Participate as the USFHP, Brighton Marine, physician representative in all national forums and workgroups related to medical and quality management for the US Family Health Plan.
• Develop and maintain relationships with key stakeholders, including hospitals, payers, and government agencies.
• Represent BMI in professional and regulatory forums.

Qualifications

Education & Experience

• Doctor of Medicine (MD) degree or Doctor of Osteopathic Medicine (DO) degree.
• Minimum 5 years of experience in clinical leadership, managed care, and healthcare administration.

Licensure & Certifications

• Active and unrestricted medical license.
• Board certification in a relevant medical specialty.

Skills & Competencies

• Strong leadership, strategic planning, and decision-making skills.
• Expertise in medical management, utilization review, and provider engagement.
• Knowledge of healthcare regulations, clinical operations, and patient safety.
• Proficiency in healthcare data analytics and performance measurement tools.
• Ability to develop and implement clinical quality initiatives.
• Commitment to patient-centered care.

Physical Nature of the Job

Some elements of the job are sedentary, but the employee will be required to stand for periods of time or move throughout the campus.

Equal Opportunity Employer Statement

Brighton Marine is an Equal Opportunity Employer. We prohibit discrimination and harassment of any kind based on race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, genetic information, protected veteran status, or any other characteristic protected by federal, state, or local law. We strongly encourage applications from veterans and individuals with disabilities. Accommodations are available upon request for candidates taking part in all aspects of the selection process.

Work Authorization

Candidates must be authorized to work in the United States without sponsorship now or in the future.