Join Martin's Point Health Care, an innovative not-for-profit organization dedicated to transforming health care and enhancing community health. Our mission is to deliver exceptional care and coverage to the people of Maine and beyond. At Martin's Point, we foster a culture of trust, respect, and continuous learning—creating an enjoyable workplace environment that has earned us recognition as a certified 'Great Place to Work' since 2015. Position Summary The Associate Medical Director provides essential clinical leadership and direction to the utilization and care management functions of Martin's Point’s Health Plans. Collaborating with various functions such as Health Management, Compliance, Appeals, Network Management, Member Services, and others, you will have the opportunity to drive clinical programming, enhance quality management, and build external relationships. This role reports to the Vice President Health Plan Medical Director and closely coordinates with other Health Plan leaders. Key Responsibilities: Assist in managing health plan medical costs by ensuring clinically appropriate health care delivery using Evidence-Based Guidelines, providing members with the right service at the right time and place. Conduct medical necessity reviews for health plan-covered services and handle disputes and appeals in compliance with relevant regulations. Engage in case reviews to ensure quality and safety of care provided to Martin's Point Health Plan members. Support the development of annual Utilization Management, Care Management, and Disease Management Program Descriptions, ensuring they align with accreditation and regulatory standards (e.g., NCQA, CMS, TRICARE). Contribute to the review and development of medical policies. Collaborate with Informatics, Network Management, and Medical Economics to effectively assess and communicate cost management strategies for Network providers. Deepen understanding of Accountable Care Organizations (ACOs) and assist in their management and strategic initiatives. Provide support for Health Plan risk adjustment activities as required. Stay informed on key performance metrics, particularly around utilization, cost management, and clinical quality improvement initiatives, including HEDIS. Qualifications: Board-certified physician with post-graduate experience in direct patient care. Experience in medical leadership or focused activities within a Health Plan is preferred. Familiarity with process improvement tools. Background in Health Plan utilization management. Experience in Medicare Advantage and/or TriCare is a plus. Licenses and Certifications: Active and unrestricted license to practice medicine in Maine or New Hampshire, or eligibility for licensure in these states. Current clinical experience with patients is preferred. Skills and Competencies: In-depth knowledge of Health Care systems and Managed Care concepts. Strong commitment to performance-based Health Plan systems. Excellent analytical skills to identify trends and improvement targets. Exceptional interpersonal skills with the ability to build relationships with providers, service vendors, and internal teams. Open-mindedness to explore innovative medical management methods. Embody and support the culture and values of Martin's Point Health Care. This position is not eligible for immigration sponsorship. We are an equal opportunity/affirmative action employer.