Provide clinical leadership for medical management programs, including utilization management, prior authorization, concurrent review, case management, and care coordination by developing strategies to optimize site of care and reduce avoidable inpatient admissions, readmissions, emergency department utilization, and unnecessary high-cost services. This role partners closely with line of business leadership, network and provider contracting, actuarial, finance, quality, pharmacy, analytics, care management, and operations to improve clinical outcomes, member experience, provider performance, and total cost of care while ensuring compliance with CMS requirements.