Medical Director, Clinical Regulatory Affairs

About the role:

As an executive physician leader in this role, you will develop the Clinical Policy, Regulatory, and Compliance functions within the Office of Clinical Affairs. You will ensure our clinical operations meet healthcare laws and standards, develop and maintain regulatory policies, manage compliance risks, and guide policy-related submissions. You will advise senior leadership and work with teams across the organization to ensure clinical operations align with policy and regulatory intent.

You will report into the VP, Clinical Affairs

Responsibilities:

• Lead the Clinical Policy & Regulatory Affairs team.
• Build and manage processes that ensure clinical policy compliance and quality.
• Develop BIPs, SOPs, and other clinical policy documents aligned with QMS.
• Be a regulatory compliance expert and maintain relationships with important clinical teams.
• Deliver executive briefings on regulatory and policy impacts.
• Advise the CMO and senior leaders on compliance risks and strategy.
• Support interactions with federal and state regulators (FDA, CMS, state DOI).
• Oversee the Clinical Coding Center of Excellence and clinical credentialing.
• Promote a culture of compliance through training and education.
• Collaborate with team members across the organization.

Requirements:

• Active, unrestricted MD or DO license
• 10+ years of experience in healthcare or the health insurance industry
• 5+ years of experience in clinical policy compliance or clinical regulatory/government affairs
• 5+ years applying state and federal health insurance laws and regulations (Marketplace, MA, reporting, and audit requirements)
• 5+ years preparing and presenting reports to boards of directors
• 5+ year of team leadership and people development experience

Bonus points:

• JD or other legal training/certification in addition to physician credentials
• Experience with ACA or commercial health plans