Clinical Risk Manager Jobs in Orlando, FL (NOW HIRING)

At Claremedica, exceptional is the standard.

Driven by our purpose to enhance the lives of the seniors in the communities where we have the privilege to work, live, and play, the Claremedica team is comprised of the brightest and best in their fields of expertise. From clinical excellence to unparalleled administrative support and beyond, we’re working together to help seniors live happier, healthier, fuller lives.

That kind of teamwork and passion for excelling can only exist in a workplace that fosters employees’ growth and wellness and where their full potential and value are realized. At Claremedica, we’re excited about great people like you. We’re even more excited to support you with the resources, training, benefits, competitive compensation, and more to help you thrive and succeed in our communities.

Opportunity awaits – welcome to Claremedica.

ESSENTIAL FUNCTIONS

As the Regional Medical Director, you provide strategic clinical leadership and oversight across multiple care centers within your assigned region. You are responsible for ensuring consistent delivery of high-quality, value-based care by a diverse team of providers including physicians, APRNs, PAs, Acupuncturists and Specialists who will directly report to you. Your role primarily focuses on driving the clinical outcomes of your centers through reducing hospital sick days, managing medical expenses for each clinic and improving quality metrics such as HEDIS and Star Ratings, managing regulatory compliance, and supporting clinical-operational goals across all centers in your assigned region in partnership with your operational business partner.

You collaborate closely with clinical, operational, and executive teams to foster a culture of continuous improvement, patient-centered care, and provider development, while navigating the complexities of managing varied clinical settings and specialties.

DUTIES AND RESPONSIBILITIES

Clinical Leadership & Oversight

• Provide clinical leadership across multiple care centers, ensuring standardized, evidence-based care delivery and alignment with the organization’s model of care.
• Maintain clinical credibility through active engagement in patient care as appropriate.

Medical Cost & Utilization Management

• Lead strategies to optimize medical cost and utilization, promoting high-value, cost-effective care.
• Partner with clinical and operational teams to manage total cost of care and reduce unnecessary variation.

Dyad Partnership

• Collaborate closely with the Director of Operations to align clinical and business priorities.
• Maintain regular communication on clinical performance, provider engagement, and care model execution.
• Co-own performance outcomes, including clinical KPIs, incentive alignment, and patient outcomes.

Quality & Value-Based Care

• Drive quality improvement initiatives across measures such as HEDIS, Star Ratings, risk adjustment, and patient experience.
• Support population health strategies, care gap closure, and preventive care initiatives aligned with Centers for Medicare & Medicaid Services standards.

Provider Leadership & Development

• Lead and support a multidisciplinary team of physicians, APRNs, PAs, Acupuncturists and Specialists fostering a culture of accountability and continuous improvement.
• Partner on provider recruitment, onboarding, credentialing, and ongoing professional development.

Network & Care Coordination

• Build and maintain strong relationships with hospitalists, specialists, SNFs, and ancillary providers to support a high-performing, narrow network.
• Lead initiatives to improve care coordination and integration across care settings.

Compliance & Risk Management

• Ensure adherence to all federal, state, and organizational regulatory requirements.
• Oversee clinical risk management, including incident review, investigations, and corrective actions.

Operational Collaboration

• Partner with operational leaders to optimize clinical workflows, resource utilization, and patient access.
• Support implementation of care models that enhance efficiency and patient outcomes.

Performance Management & Analytics

• Analyze clinical performance data to identify trends, gaps, and opportunities.
• Implement targeted interventions and monitor outcomes to drive continuous improvement.

Governance & Strategy

• Participate in regional governance, quality committees, and strategic planning efforts.

• Serve as a key liaison between clinic providers, regional leadership, and corporate medical leadership.

SUPERVISORY RESPONSIBILITIES

• This position has supervisory responsibilities.

QUALIFICATIONS/REQUIREMENTS

• Medical degree (MD or DO) from an accredited institution.
• Board certification in Family Medicine, Internal Medicine, or other relevant specialty.
• Active, unrestricted medical license in Florida.
• Minimum 7 years of clinical experience with at least 3 years in leadership or multi-site medical management.
• Accountability for regional Medicare Advantage medical cost economics
• Understanding of medicare advantage value-based care, population health, and quality measurement frameworks.
• Demonstrated leadership ability managing diverse clinical teams and complex healthcare environments.
• Exceptional communication, organizational, and analytical skills.
• Proficiency in EMR systems, clinical documentation, and data-driven decision-making.

PREFERRED QUALIFICATIONS

• Strong understanding of Medicare advantage medical cost economics
• Understanding of best practice and compliant coding practices in a medicare advantage population

WORKING CONDITIONS

General office working conditions.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential function. 

While performing the duties of this job, the employee will be required to stand, walk, sit, use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; climb stairs, balance; stoop, kneel, crouch or crawl; talk or hear. The employee must occasionally lift and or move up to 15 pounds. Specific vision abilities required by the job include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust your focus.  Manual dexterity is required to use desktop computers and peripherals. 

WORK ENVIRONMENT

The work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of his job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. 

The noise level in the work environment is usually moderate.

TRAVEL

Regular consistent travel to your medical centers to provide direct clinical engagement is required.  Centers are located regionally and the expectation is direct engagement every week.

SAFETY HAZARD OF THE JOB

This job description does not list all the duties and responsibilities of the job.  You may be asked by supervisors or managers to perform other instructions, duties, and responsibilities, as appropriate. You will be evaluated in part based upon your performance of the duties and responsibilities identified in this job description.

Management reserves the right to revise this job description at any time to meet organizational needs. This job description is not intended to create a contract of employment. Employment with the organization is on an at-will basis unless otherwise specified in a written employment agreement, meaning either the employee or the employer may terminate the employment relationship at any time, with or without cause or notice, in accordance with applicable law.