MEDICAL DIRECTOR — Northeast
Our client, a regional not-for-profit health plan, has retained The French Group to assist them in identifying a medical director to add to their team. The Medical Director will oversee the health plan’s medical management programs and provide medical leadership in the provision of quality, cost efficient care and service to their members.
Manages use of medical resources for inpatient and outpatient services; determines medical appropriateness through the application of clinical criteria; performs case management review; and, participates in the clinical appeals process.
Establishes and maintains continuity in the planning, development and implementation of policies, operational processes, and workflows required to execute organizational strategies and to assure consistency in process application throughout Medical Management.
Serves as an essential liaison among Senior Management, Plan staff, contracted providers, vendors, and membership to promote and improve communication and operations.
Analyzes medical cost drivers and develop specific plans to reduce excessive cost.
Assists in the development and implementation of new policy and programs as needed.
Works with health plan leadership to develop strategic approaches to improving company performance and expanding growth by optimizing provider network, evaluating provider contracts, and developing other creative approaches.
MD or DO with unrestricted license to practice medicine
Current board certification preferably in primary care specialty.
10+ years clinical experience plus managed care medical director experience or equivalent of at least two years.
Exceptional presentation, communication, organizational and project management skills.
Ability to work well with teams across departmental lines. Desire to make a difference. Adaptable and embraces change as an opportunity.
For additional information and/or confidential consideration, please contact:
CONSULTANT: Tricia French, RN, BSN
President & CEO
The French Group