Sr. Director of Population Health Management & Medical Director

MISSION
Our mission is to enhance well-being by connecting individuals with vital health resources through a compassionate workforce that embodies the spirit of neighbors helping neighbors.

VALUES
HealthOne is guided by a cultural framework that embodies our values and drives our decisions.

Our PURPOSE is to care for people by connecting them to resources that help protect them in health related situations. To fulfill our purpose, we align our PRIORITIES to ensure each decision we make is ethical, empathetic, economical, and efficient. We care for PEOPLE by being welcoming, authentic, truthful, consistent, and humble. We are continuously looking for ways to improve our PROCESS and how we get things done.

HealthOne seeks individuals with integrity and heart to embody our values. Whether youre starting your career or looking to develop additional skills to reach your full potential, HealthOne provides the means to help you achieve your goals.

JOB PURPOSE
The Senior Director of Population Health Management has operational and strategic oversight for Case Management, Care Coordination, Utilization Management, and the organizations Population Health Management strategy. This role is responsible for designing, executing, and continuously improving enterprise-wide programs that drive health outcomes, quality performance, and manage the overall medical expense of the organization. This leader translates regulatory guidance and clinical best practices into scalable care management, utilization management, and care coordination, delivering measurable results for members, providers, and the business.

ESSENTIAL JOB DUTIES
Strategy & Governance
Serve as a key member of the executive leadership team, partnering across clinical, financial, and operational domains to design and implement clinically driven financial improvement strategies that optimize care quality, reduce avoidable costs, and sustain long term organizational performance.
Develop the multi-year Population Health strategy and annual operating plan aligned to Alliants strategic objectives.
Establish policies, programs and standard operating procedures across Case Management, Utilization Management, and Care Coordination.
Chair cross-functional steering forums; ensure clear decision rights, cadence, and accountability.
Act as a strategic thought partner to the Sr Director of Data Governance, Risk Adjustment & Medical Economics on the development and implementation of a Medical Economics strategy for the organization.

Care & Utilization Management
Oversee clinical programs: complex case management, disease management, transitions of care, and utilization management; ensure evidence-based protocols, appropriateness, and equity.
Build referral pathways and reporting for specialty programs and ensure efficient vendor collaboration and notifications.

Provider & Member Quality Engagement
Develop provider engagement strategies (scorecards, incentives, care gap workflows, clinical collaboration) in partnership with the Sr. Director of Data Governance, Risk Adjustment & Medical Economics to drive improvement in Alliants medical trend.
Lead the development of quality improvement initiatives that enhance member health outcomes and achieve measurable gains in HEDIS performance, ensuring compliance with NCQA standards and successful annual audit outcomes.

Operations & Talent
Lead day-to-day operations across PopHealth teams; drive capacity planning, workforce management, and continuous improvement.
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
Current MD or DO degree with an unencumbered and unrestricted license to practice medicine in Georgia and Tennessee required
5 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

HEALTHONE IS AN EQUAL OPPORTUNITY EMPLOYER
All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, disability, sex, age, ethnic or national origin, marital status, sexual orientation, gender identity or presentation, pregnancy, genetics, veteran status, or any other status protected by state or federal law.