IPA Medical Director (San Juan)

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GENERAL DESCRIPTION:

Provide clinical leadership to support the performance, compliance, and medical cost efficiency of IPAs operating under models 330 and 999. Holding an active physician license in Puerto Rico, this role acts as the primary clinical liaison between the organization and its affiliated IPAs. The IPA Medical Director collaborates closely with other department teams to monitor key performance indicators (KPIs), identify opportunities for clinical optimization, and ensure regulatory compliance. The Director is a key member of the IPA Committee and leads medical reviews and analytics-driven initiatives to improve population health outcomes, reduce unnecessary utilization, and support value-based care delivery.

GENERAL DESCRIPTION:

Provide clinical leadership to support the performance, compliance, and medical cost efficiency of IPAs operating under models 330 and 999. Holding an active physician license in Puerto Rico, this role acts as the primary clinical liaison between the organization and its affiliated IPAs. The IPA Medical Director collaborates closely with other department teams to monitor key performance indicators (KPIs), identify opportunities for clinical optimization, and ensure regulatory compliance. The Director is a key member of the IPA Committee and leads medical reviews and analytics-driven initiatives to improve population health outcomes, reduce unnecessary utilization, and support value-based care delivery.

ESSENTIAL FUNCTIONS:

• Serve as the primary medical liaison between the organization and IPAs 330 and 999, offering clinical oversight and guidance.
• Lead clinical reviews and provide recommendations based on performance, utilization, and cost reports.
• Interpret and act on claims data, quality indicators, and medical cost analytics to identify trends and actionable areas for intervention.
• Collaborate with Provider Operations to develop and monitor improvement plans for IPAs, focused on cost containment, preventive care, and chronic condition management.
• Participate in the IPA Committee, providing clinical interpretation of data and recommendations for corrective action plans when needed.
• Provide medical direction for strategies targeting unmanaged or high-risk membership, with an emphasis on reducing ER overuse, readmissions, and avoidable admissions.
• Support financial forecasting by offering clinical insight into IPA-level performance and utilization trends.
• Ensure documentation and coding practices are aligned with risk adjustment and quality measurement frameworks.
• Monitor provider engagement, member outcomes, and resource use to ensure the delivery of coordinated, efficient care.
• Represent the organization in provider-facing meetings, educational sessions, and clinical summits as needed.
• Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
• May perform other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.

MINIMUM QUALIFICATIONS:

Education and Experience: Medical Degree (MD or DO). At least seven (7) years of clinical experience, including experience in managed care, medical management, or provider network oversight. Familiarity with IPA models of care (especially 330 and 999), value-based contracts, population health strategies, clinical data analysis, utilization management, and cost containment strategies is highly desirable.

Certifications / Licenses: An active medical license to practice in Puerto Rico is required.

Other: Prior experience working directly with IPA models, particularly 330/999, or in value-based care programs, preferred.

Languages:

Spanish Advanced (comprehensive, writing, and verbal)

English Advanced (comprehensive, writing, and verbal)

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Seniority level

• Seniority level

  Director

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Insurance

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