Group 1001
is a consumer-centric, technology-driven family of insurance companies on a mission to deliver outstanding value and operational performance by combining financial strength and stability with deep insurance expertise and a can-do culture. Group1001’s culture emphasizes the importance of collaboration, communication, core business focus, risk management, and striving for outcomes. This goal extends to how we hire and onboard our most valuable assets – our employees.
Company Overview:
Clear Spring Health is part of Group One Thousand One (“Group1001”), a customer-centric insurance group whose mission is to make insurance more useful, intuitive and accessible so that everyone feels empowered to achieve financial security. Clear Spring Health is dedicated to helping seniors protect their health and well-being by providing Medicare Advantage plans in select counties of Colorado, Illinois, North Carolina, and Virginia, plus Georgia and South Carolina and offers Medicare Prescription Drug Plans in 42 states plus DC.
Why This Role Matters:
At Clear Spring Health, we believe in simplifying health to enrich lives. As our Medical Director, you’ll help lead the way in delivering high-quality, person-centered care to the people we serve. This role is central to ensuring our Medicare Advantage members receive care that’s thoughtful, timely, and based on what works best.
What You’ll Do:
- Assists clinical teams to ensure prompt and reliable communication with members and providers.
- Offers strategic input on the operational components of clinical programs.
- Conducts collaborative peer-to-peer clinical evaluations with attending physicians or other healthcare professionals to discuss case outcomes and patient consultations.
- Participate in peer-to-peer appeal review discussions with attending physicians or ordering providers to clarify review results.
- Acts as a trusted advisor and subject matter expert for various departments across the organization.
- May be asked to represent the organization in external engagements and/or serve on both internal and external panels or committees.
- May preside over internal corporate committees.
- Interprets clinical protocols and healthcare policies.
- May recommend and design new clinical policies in response to evolving medical practices and trends.
- Oversees, shapes, and drives both clinical and administrative initiatives that influence healthcare outcomes, cost-effectiveness, and quality.
- Recognizes and advances innovative solutions to improve efficiency and enhance service excellence.
What You’ll Bring:
- A Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree.
- An active, unrestricted medical license in the U.S.
- Board certification in your clinical specialty. Gerontology or Internal Medicine preferred
- At least 7 years of clinical experience, plus 5 years in a leadership role within a health plan or managed care organization.
- A deep understanding of Medicare Advantage regulations, STAR measures, and what quality care looks like in real life.
- An affinity toward driving measurable business outcomes and thinking strategically.
- Background using data to assist with informing key decisions and the ability to use data analysis tools.
- Experience leading utilization management and quality programs that meet CMS and NCQA standards.
- A clear, compassionate communication style—and a talent for working across teams and disciplines.
- Occasional travel (up to 20%) may be needed for meetings, partner visits, or regulatory events.
It Would Be Helpful If You Have:
- Experience with D-SNPs, C-SNPS or other Medicare Advantage plan types.
- Knowledge of value-based care and population health.
- Familiarity with health equity strategies and social drivers of health.
- A strong understanding of delegated model operations.
Compensation:
Our compensation reflects the cost of labor across several U.S. geographic markets. The base pay for this position ranges from $200,000/year in our lowest geographic market up to $250,000/year in our highest geographic market. Pay is based on factors such as market location, job-related skills, and experience
Benefits Highlights:
Employees who meet benefit eligibility guidelines and work 30 hours or more weekly, have the ability to enroll in Group 1001’s benefits package. Employees (and their families) are eligible to participate in the Company’s comprehensive health, dental, and vision insurance plan options. Employees are also eligible for Basic and Supplemental Life Insurance, Short and Long-Term Disability. All employees (regardless of hours worked) have immediate access to the Company’s Employee Assistance Program and wellness programs—no enrollment is required. Employees may also participate in the Company’s 401K plan, with matching contributions by the Company.
Group 1001, and its affiliated companies, is strongly committed to providing a supportive work environment where employee differences are valued. Diversity is an essential ingredient in making Group 1001 a welcoming place to work and is fundamental in building a high-performance team. Diversity embodies all the differences that make us unique individuals. All employees share the responsibility for maintaining a workplace culture of dignity, respect, understanding and appreciation of individual and group differences.
