Remote Utilization Management Jobs in Illinois (NOW HIRING)

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Job Description:

Director, Affordability

Alpine Physician Partners | Remote-Flexible

The Role

This role is responsible for owning and driving Alpine's medical expense reduction program across all markets. Working in close partnership with the Chief Clinical Officer, you will take clinical programs from concept through full operational deployment; help build, support and manage a portfolio of clinical and operational interventions; lead vendor (those that support and accelerate affordability programs) selection and performance management; and construct the measurement infrastructure to track both program execution progress and financial impact at the program and PMPM (patient/membership) level.

What You Will Own

• MedEx framework ownership. In partnership with the Chief Clinical Officer, develop and maintain a framework for identifying, sizing, prioritizing, and implementing interventions that drive PMPM medical expense reduction across the full member population.

• Vendor programs and management. Lead vendor evaluation, selection, contracting, and ongoing performance management with Alpine vendors designed to accelerate and appropriately manage/reduce unnecessary medical spend. Hold vendors accountable to real-world admission reduction benchmarks. Where appropriate, interface with internal technology team to ensure appropriate technology specifications and safeguards have been evaluated and implemented.

• Chronic and complex disease management, Advanced life and palliative care planning, and Hospice-appropriate care. Own and drive clinical program deployment across Alpine's advanced illness portfolio, including hospice, palliative care, and disease management programs such as CHF and complex chronic condition management. Lead programs through the full lifecycle: clinical design, clinician and site engagement, patient identification and activation, vendor acceleration where applicable, and ongoing performance management. Ensure clinic-level workflows and patient touchpoints are operational, not just contracted.

• Hospital divergence and ED diversion. Design and manage programs to reduce avoidable admissions, readmissions and ED utilization in partnership with regional operations leads and clinic teams.

• Referral integrity and specialty utilization. Partner with Market CMOs and clinic teams to implement referral integrity review at the point of order, ensuring appropriate use of specialty referrals, differential utilization of high-value and in-network specialist, optimizing internal and curb-side consultation when appropriate routing, and ultimately reducing unnecessary specialty spend. Where appropriate, support in the JOC (joint operating committee) meetings with network specialists, and/or support the financial modeling of alternative payment strategies such as sub-capitation of the high-value and in-network specialists.

• Program KPI framework, ROI tracking, and cross-functional reporting: Working with business analytics team, serve as the business owner (along with the Chief Clinical Officer) to own Alpine's MedEx measurement and reporting infrastructure, with a two-layer reporting cadence: (1) leading indicators of program execution-enrollment velocity, clinician activation rates, vendor milestone adherence, patient touchpoint completion-that signal whether programs are on track before financial results materialize; and (2) lagging financial impact measures-intervention-level PMPM savings, program ROI, utilization rate trends (admissions, ED visits, SNF days), and cost-per-member-per-program. Partner with IT/Data and Business Analytics to build the data infrastructure and with Finance to validate methodology and integrate into board- and investor-facing performance reporting.

What We Are Looking For

• Demonstrated track record driving medical cost improvement in a full-risk Medicare Advantage or value-based care setting; experience with both plan-side affordability programs and provider-side utilization management is a strong differentiator

• Demonstrated ability to drive clinical programs from concept to live operations, including engaging clinicians and site teams, activating patients, managing vendor partnerships to accelerate program maturity, and delivering against defined utilization and financial targets; experience with hospice, advanced illness, CHF or other disease management programs highly valued

• Ability to evaluate vendors rigorously, including building financial models, stress-testing assumptions, and holding partners accountable to real-world ROI rather than published estimates

• Strong cross-functional operator: equally effective engaging frontline clinicians and clinic site teams as partnering with IT on data infrastructure and Finance on ROI methodology and reporting; able to manage central program execution while staying close to the ground-level realities that determine whether programs actually land

• Data-driven approach to prioritization and decision-making; able to build or direct the build of PMPM-level cost impact models and intervention tracking infrastructure

• Experience working across network, clinical, and finance functions to design and execute cost reduction strategies in a multi-market environment

Preferred Background

• Clinical fluency sufficient to design workflows, engage clinical teams with credibility, and evaluate program design quality; a formal clinical credential (RN, LVN, or similar) is a plus but not required; MBA or MHA welcome where paired with meaningful clinical operations exposure

• Background in Medicare Advantage plan affordability, value-based care operations, or health system utilization management

• Familiarity with MSSP program mechanics and dual MA/ACO operating environments

• Experience building or scaling a MedEx or affordability function

If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!