MEDICAL DIRECTOR – Mid Atlantic Health Plan


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The French Group has been retained by one of the nations most reputable health plans to assist in the selection of their new medical director. This position reports to the Senior Medical Director – a reflective, seasoned and respected physician executive. The Medical Director is responsible for providing medical management leadership to ensure the delivery of high quality, consumer centric and cost effective medical care. These responsibilities include medical utilization management, medical community relationships, network development and maintenance.

Specific Responsibilities include:

Provides leadership to strategic medical management of markets
-Provides clinical guidance and oversight in operating effective medical management initiatives to achieve member quality of care
-Participation in utilization management practices including concurrent review, discharge planning and case management
-Leadership of quality management activities including those necessary to achieve NCQA accreditation
-Collaborates with practice manager in utilizing data analysis to identify opportunities for quality improvement and to positively influence practice patterns
-Participates in evaluation of product design, impact on quality, cost and service

Serves as critical medical leader for external providers and plan sponsors, including regulatory and accrediting agencies, and community in general
-Key business partner in network development strategy, to maintain member access of high quality medical care and the maintenance of a marketable, high quality, cost effective provider network
-Leader in improving and maintaining positive relations with physicians and hospitals
-Provides value-added support to sales and marketing efforts
-Assures compliance to regulatory requirements and core company policies

Key Competencies:

Business and Organizational Knowledge
-Understands drivers of healthcare costs and applies clinically appropriate solutions
-In-depth knowledge of industry, products, consumer market, competitive intelligence, and legislative climate
-Strong technical knowledge of patient management and network management functions
-Understands the inter relationship of medical activities to pricing and underwriting
-Strong understanding and proficiency in use of metrics and measures in managing programs and services

-Builds solid collaborative relationships, both internal and external
-Effectively communicates rationale for decisions
-Skilled in negotiation and conflict resolution. Demonstrates ability to influence others, win support on critical issues and reach consensus when appropriate
-Presents a positive, professional image of the company in representing Aetna to the media, regulatory/governmental groups and medical organizations

Management of Resources
-Prioritizes and allocates organization resources (time, cost, human and technical) while effectively balancing needs to achieve objectives
-Encourages business process and product/service improvement initiatives
-Utilizes available technology to achieve results
-Adept at working across a highly matrixed organization to influence resources that are not direct reports
-Assures that medical management is represented in all cross functional activities where appropriate

Leadership and Teamwork
-Demonstrates ability to quickly and effectively execute plans and inspires motivation of others
-Demonstrates a commitment to high service standards and a passion for making positive changes within the organization and the healthcare system
-Demonstrates openness, flexibility and willingness to accept alternative viewpoints
-Supports ongoing development of clinical staff via mentoring, training, special projects/job assignments, etc.
-Encourages appropriate risk taking and creative thinking
-Negotiates resolution to barriers to achieving mission
-Builds trust by demonstrating high ethical standards and personal integrity
-Works collaboratively and encourages cross functional thinking to assist employees understand how medical management/ their role impacts overall business

Customer Focus
-Recognizes complexity of managing the needs of multiple customers (plan sponsors, members, providers, brokers and consultants)
-Proactively identifies customer needs on continual basis and acts on them consistent with strategic direction
-Exercises sound business judgment in responding to customers needs

Attributes of the ideal candidate
-Sound clinical knowledge and well respected by the physician community
-Understands the health benefits business, clincial issues, trends and medical management
-Strategic thinker, yet pays attention to the details
-Intuitive and market savvy – anticipates customers needs/concerns/reactions and proactively presents opportunities and options
-Demonstrates a bias for actions consistent with strategy
-Can operate successfully in a highly matrixed and fluid environment
-Possesses exceptional interpersonal, listenting and presentation skills
-Takes the initiative to support ongoing training and development of clincial staff
-Driven to develop and implement creative, realistic solutions
-Highly organized and prioritizes multiple tasks with impeccable follow through

Desired Background
-M.D. or D.O. with current board certification in a recognized specialty
-Active state medical license without encumbrances
-Minimum of 5 years clinical practice experience
-Minimum of 2 years leadership experience in a managed care organization

For additional information and/or confidential consideration, please contact Tricia French at or 757-362-0202.