Insurance Medical Director Jobs in Decatur, GA (NOW HIRING)

WHO IS GUIDEHEALTH? 

Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers. Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers. Physician-led, Guidehealth empowers our partners to deliver high-quality healthcare focused on outcomes and value inside and outside the exam room for all patients.  

As a growing and innovative organization, we operate with a high degree of agility. Employees are expected to adapt to evolving business needs, step in to support cross-functional initiatives, and contribute beyond traditional role boundaries when needed. This collaborative and flexible mindset is essential to our success. We encourage cross-training, ongoing development, and a commitment to learning across all areas of the business—ensuring we continue to grow and you continue to thrive as a high-performing, mission-driven team.

Join us as we put healthcare on a better path!! 

The Sr. Director, Health Plan Relationships is the executive owner of assigned self-insured health plan client relationships and serves as the primary liaison between client leadership and internal operations. This role is accountable for seamless client transition from Sales through implementation and into ongoing performance management and servicing. 

The Sr. Director owns the day-to-day executive relationship, performance delivery oversight, and strategic value realization across care management, analytics and analytic platform, utilization management, claims processing, benefits administration, and HEDIS quality performance. 

The Sr. Director ensures that each client achieves measurable improvement in total cost of care, utilization efficiency, quality outcomes, and member experience — positioning the organization as the market-leading high-value, low-cost partner in value-based health plan services. 

Why This Role Matters 

This position ensures seamless transition from commercial promise to operational performance. By owning the full client lifecycle — from contract signature through implementation and into measurable value realization — the Sr. Director directly safeguards retention, revenue stability, and market differentiation. 

WHAT YOU'LL BE DOING  

Client Transition, Implementation & Lifecycle Ownership 

• Serving as the executive owner of new client transitions from Sales to contract execution. 
• Leading formal handoff process from Sales to Operations, ensuring scope clarity, contractual alignment, performance guarantees, and implementation readiness. 
• Working with Operations to develop a summary implementation plan that can be used for client alignment and tracking 
• Establishing implementation governance structure, milestone tracking, and executive reporting cadence. 
• Ensuring on-time, on-budget, and contractually compliant go-live. 
• Partnering with implementation, operational, and consultative teams to drive successful onboarding, including, where applicable, based on contract scope: 
• Data integration and eligibility feeds 
• Claims platform setup and configuration 
• Benefit plan build validation  
• Utilization management program alignment 
• Care management workflows and member outreach readiness 
• Analytics platform deployment and reporting configuration 
• Transitioning the client from the implementation phase to steady-state servicing with clear performance baseline metrics and first-year value roadmap. 
• Maintaining continuous lifecycle ownership through renewal and expansion. 

Executive Relationship Ownership 

• Serving as the single accountable executive point of contact for assigned self-insured employer health plans. 
• Building trusted, C-suite relationships (HR, Finance, Benefits, Population Health leadership). 
• Acting as the conduit for surfacing blockers to senior client leaders (in sync with operations) in a clear, actionable, and trust-based manner 
• Leading recurring executive business reviews (QBRs), performance reviews, and strategic planning sessions. 
• Providing consultative support to client executive and operational teams to increase customer/company synergies. 
• Translating complex operational and clinical data into clear executive-level insights and actions. 
• Ensuring proactive communication of performance trends, risks, and mitigation strategies. 

 Performance Accountability & Operational Integration. Overseeing Guidehealth accountability for:

• Total cost of care (TCOC) 
• Utilization management effectiveness (IP vs ASC site-of-care optimization, medical necessity integrity, observation vs inpatient trends, SNF LOS) 
• Care management engagement and impact 
• Claims accuracy and financial integrity 
• Benefit plan performance and optimization 
• HEDIS gap closure and quality outcomes 
• Partner cross-functionally with operations, clinical leadership, analytics, and claims teams to ensure contractual performance delivery. 
• Identify operational gaps and drive corrective action plans alongside Operations with clear timelines and accountability. 

 Data-Driven Value Creation. Analyzing client-specific claims, utilization, quality, and engagement data to identify: 

• Cost containment opportunities 
• Site-of-care migration opportunities 
• Avoidable ED/IP utilization reduction strategies 
• Pharmacy optimization opportunities 
• Quality improvement and risk capture gaps 
• Benefit design leverage points 
• Develop strategic recommendations that align financial performance with improved member outcomes. 
• Quantify ROI and document realized savings and quality gains. 

Strategic Growth & Expansion 

• Identifying opportunities for service expansion within existing accounts (analytics platform adoption, UM enhancements, care management programs, etc.). 
• Supporting renewal strategy and retention through demonstrable performance and executive alignment. 
• Contributing to client case studies and market differentiation efforts. 

Member & Patient Experience Excellence 

• Ensuring care programs and operational workflows are optimized for a seamless member experience. 
• Monitoring member satisfaction indicators and recommending process improvements. 
• Advocating for client members internally to ensure frictionless navigation across services. 

 Key Performance Indicators 

• Successful new client implementations (on-time, on-budget, clean go-live) 
• Client retention and renewal rates 
• Year-over-year total cost of care trend reduction 
• Improvement in utilization efficiency (IP admits per 1,000, site-of-care optimization, SNF LOS reduction) 
• HEDIS measure improvement and gap closure rates 
• Care management engagement and impact metrics 
• Executive client satisfaction scores (NPS among executives and key influencers) 
• Expansion of revenue within existing accounts 

WHAT YOU'LL NEED FOR SUCCESS

• 4+ years of experience in healthcare client service and strategy, program implementation, and/or support for value-based care services and technologies. 
• Demonstrated experience leading client implementations and cross-functional onboarding processes. 
• Healthcare and value-based care dynamics 
• Utilization management processes 
• Claims processing and benefit administration 
• Population health analytics 
• HEDIS quality measurement 
• Demonstrated experience managing executive-level client relationships. 
• Strong financial acumen with ability to analyze cost-of-care drivers and ROI. 
• Exceptional communication and executive presentation skills. 
• Ability to travel up to 50% to client locations.

WHAT WE'D LOVE FOR YOU TO HAVE

• Clinical or advanced business degree (MBA, MHA, MPH, RN)
• Experience working with employer-sponsored health plans or TPAs. 
• Background in value-based care models or alternative payment arrangements. 
• Familiarity with population health analytics platforms and reporting tools. 

The base salary for this role is $170,000.00 to $180,000.00. This is a fully remote position with expected travel up to 50% to various client locations. 

ALIVE with Purpose: How We Thrive at Guidehealth 

At Guidehealth, our values come to life in everything we do. 

• We are Driven by Accountability — grounded in transparency, reliability, and integrity as we navigate challenges and opportunities alike. 
• Always Growing, Always Learning — staying curious and continuously improving inspires us to shape a better future for healthcare. 
• With Collaborative Innovation, we solve problems creatively, making every experience better for our employees and the patients we serve. 
• At Guidehealth, Every Voice Matters — we believe our collective strength is rooted in the unique perspectives of each team member. 
• And through Empathy in Action, we build stronger connections with those who count on us. 
• This is what it means to be ALIVE with purpose. This is how we thrive — together — at Guidehealth. 

BENEFITS:

While you are hard at work advancing value-based healthcare, we are here to ensure YOU have the care you and your family need and the opportunities for growth and development. Our commitments to you include:

• Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
• Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep you covered.
• Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.
• Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments. Additionally, we offer voluntary Life options to keep you and your loved ones protected.
• Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times.
• Take Time for Yourself: We offer paid time off plans helping you achieve work-life balance and meet your personal goals.
• Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need.
• Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.

All full-time employees of Guidehealth who work 30 hours per week or more are eligible for our comprehensive benefits package. Temporary employees and contractors are not eligible for benefits.

COMPENSATION:

The listed compensation range listed is paid bi-weekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include, but are not limited to: skill set, years of relevant experience, education, location, and licensure/certifications.

OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT 

Diversity, inclusion, and belonging are at the core of Guidehealth’s values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race, religious creed, color, age, sex, sexual orientation and identity, national origin, citizenship, religion, marital status, familial status, physical, sensory, or medical disability, Family and Medical Leave, military or veteran status, pregnancy, childbirth or other related medical conditions, or any other classification protected by federal, state, and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring, placement, promotion, transfer, demotion, layoff, termination, recruitment advertising, pay, and other forms of compensation, training, and general treatment during employment.  

OUR COMITTMENT TO PROTECTION OF PATIENT AND COMPANY DATA

This position is responsible for following all Security policies and procedures in order to protect all PHI and PII under Guidehealth’s custodianship as well as Guidehealth Intellectual Properties.  For any security-specific roles, the responsibilities would be further defined by the hiring manager. 

As a remote-first organization handling sensitive healthcare data, Guidehealth verifies candidate identity at multiple stages of the hiring and onboarding to safeguard patient privacy, data security, and compliance requirements.

REMOTE WORK TECHNICAL REQUIREMENTS
Guidehealth is a fully remote company. We provide new employees with the necessary equipment to function in their role at no charge to the employee. Employees provide their own internet connection, capable of conducting video calls on camera and connecting to various internal and external systems. The required internet speed is a minimum of 100 mbps download, 10 mbps upload. Please run a speed test here to confirm your internet connection meets these requirements. 

SECONDARY EMPLOYMENT

At Guidehealth, we value transparency and collaboration as part of our commitment to excellence. As your primary employer, we kindly ask all team members to disclose any secondary employment, regardless of whether it may present a potential conflict of interest. 

To ensure smooth teamwork and availability, employees must be accessible during our stated working hours. We foster connection and engagement by asking team members to join virtual meetings with their cameras on.