Medical Director, Care & Case Management

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Medical Director, Care & Case Management based in the United States.

This physician leadership role oversees the strategic direction, operational performance, and clinical quality of care, case, and utilization management programs.
The position combines medical expertise with strong operational ownership to improve outcomes, optimize workflows, and support scalable healthcare delivery.
The ideal candidate will lead evidence-based care models, drive performance against key clinical metrics, and ensure high-quality member experiences.
Working across clinical, product, engineering, and operational teams, this leader will help shape innovative approaches to population health management.
The role offers the opportunity to influence care delivery models, integrate emerging technologies, and improve healthcare accessibility.
This is a high-impact position for a physician executive who thrives in complex environments and enjoys building programs that create measurable value.

Accountabilities:

The Medical Director, Care & Case Management will provide clinical leadership and operational oversight for care management programs, ensuring they achieve quality, efficiency, and performance goals. This role requires a strategic yet hands-on leader who can translate healthcare priorities into scalable clinical operations, improve member outcomes, and guide teams through continuous improvement initiatives.

• Serve as the primary clinical escalation point for care management, case management, and utilization management programs.
• Establish and maintain evidence-based clinical standards, care pathways, and quality expectations across programs.
• Own clinical performance metrics, define success targets, analyze gaps, and implement improvements to achieve operational goals.
• Review program data, identify performance trends or workflow issues, and drive solutions through structured improvement initiatives.
• Lead operating rhythms including performance reviews, escalation management, and accountability tracking.
• Develop and evolve clinical operating models across adult, maternity, and pediatric populations to support broader healthcare strategies.
• Partner with Product and Engineering teams to design, validate, and implement AI-enabled tools within clinical workflows.
• Ensure AI-generated insights and recommendations are clinically accurate, actionable, and aligned with patient care standards.
• Build new care models and scalable programs that improve healthcare outcomes across diverse populations.
• Lead, mentor, and develop clinical leaders while fostering accountability, collaboration, and professional growth.
• Represent care management initiatives in cross-functional programs, strategic planning efforts, and operational improvements.
• Collaborate with quality teams to establish processes that ensure consistent, high-quality member experiences.

Requirements:

The ideal candidate is an experienced physician leader with a strong background in healthcare operations, population health, and clinical program management. They should combine clinical expertise, strategic thinking, and operational discipline to improve care delivery at scale.

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree required.
• Board certification in internal medicine, family medicine, med-peds, or a related specialty.
• Minimum of 7 years of post-residency clinical experience with the ability to apply clinical expertise to population health leadership.
• At least 5 years of healthcare leadership experience managing clinical teams, programs, and other healthcare leaders.
• Active, unrestricted medical license in good standing in the state of residence, with multi-state licensure or willingness to obtain additional licenses.
• Proven experience delivering measurable results against operational KPIs, including clinical quality, productivity, and engagement goals.
• Strong understanding of care management, utilization management, complex care, and population health strategies.
• Experience leading teams through ambiguity, organizational change, and large-scale operational initiatives.
• Ability to analyze healthcare data, identify improvement opportunities, and make evidence-based decisions.
• Strong communication and stakeholder management skills, with the ability to collaborate across clinical, technical, and business teams.
• Experience with digital health, virtual care, or technology-enabled healthcare delivery preferred.
• Familiarity with integrating clinical AI tools into healthcare workflows preferred.
• Knowledge of medical, behavioral, and social factors influencing healthcare outcomes and avoidable costs preferred.
• Experience working in physician compact-eligible states is a plus.

Benefits:

• Competitive compensation package with a base salary target range of $240,720–$368,304+, plus bonus, equity, and benefits.
• Remote-first work culture with flexibility to support effective collaboration.
• Comprehensive medical, dental, and vision insurance options.
• Disability insurance coverage and additional wellness support programs.
• 401(k) savings plan through Fidelity.
• Paid Time Off (PTO) and Discretionary Time Off (DTO).
• 12 weeks of fully paid parental leave.
• Family-building support, including fertility coverage, adoption and surrogacy assistance, and compassionate leave.
• Work-from-home reimbursement to support a productive remote environment.
• Opportunities to influence innovative healthcare models and AI-enabled care delivery solutions.