REMOTE - Director Clinical Programs, Health Plan

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond.  As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community.  Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day.  Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.
 

Position Summary
 

At Martin’s Point Health Care, we’re on a mission to create healthier communities by providing high-quality, affordable care to our members—including seniors and military families. We’re looking for a Director of Health Plan Clinical Programs to help us design and deliver innovative care management strategies that drive better outcomes, lower costs, and enhance the member experience.

Job Description

As Director, you’ll provide strategic leadership for Utilization and Care Management programs that directly impact the health and well-being of our members. You’ll work closely with senior health plan leaders and lead a talented team to:

• Develop and implement new programs that improve population health and reduce costs, with a focus on evidence-based care.

• Oversee care management operations—from disease management programs (like CHF) to complex care coordination—ensuring members receive high-value support across the healthcare system.

• Drive results through data, KPIs, and reporting, monitoring performance, regulatory compliance, and accreditation standards.

• Collaborate across the enterprise, aligning with quality, compliance, and clinical teams to support STAR performance, CMS requirements, and organizational growth.

• Manage external partners and vendors, ensuring seamless integration and strong performance.

We’re seeking a leader with vision, operational expertise, and a passion for improving health outcomes. You’ll need:

• A clinical background (RN, NP, PA, PharmD, or similar licensure).

• A Bachelor’s degree in a clinical field (Master’s preferred).

• 10+ years of healthcare experience, including managed care, care/disease management, utilization management, and Medicare Advantage.

• Demonstrated success in program design, implementation, and evaluation, using data and analytics to inform strategy.

• Strong project management skills and the ability to lead through change in a matrixed environment.

• Deep knowledge of Medicare Advantage, CMS Stars, HEDIS, accreditation standards, and regulatory requirements; TRICARE experience a plus.

At Martin’s Point, you’ll be part of a values-driven organization where trust, respect, learning, and fun aren’t just words—they shape how we work every day. You’ll have the opportunity to make a meaningful impact on the lives of our members while helping shape the future of our health plan programs.

Join us and help create programs that deliver the right care, at the right time, in the right place—for every member we serve.

This is a remote role that will require occasional travel to Portland, Maine.

This position is not eligible for immigration sponsorship.

We are an equal opportunity/affirmative action employer.

Do you have a question about careers at Martin’s Point Health Care? Contact us at: jobinquiries@martinspoint.org