Medical Director Philadelphia
The French Group has been retained by our client, an award-winning not-for-profit health plan, to identify an experienced Medical Director to add to their talented team.
The Medical Director will function as an integral part of the Health Care Senior Management team with responsibility for care management, quality management and pharmacy services programs. This position will represent Health Care Management in interdepartmental activities and represent the Plan in the health system and provider communities as well as in regulatory and governmental activities. The Medical Director will apply clinical expertise and experience as a provider to promote the appropriate delivery of medically necessary services to the population served. She/he will perform utilization, pharmacy and quality reviews and will analyze and profile utilization patterns in order to meet with and direct network providers. The Medical Director will also be very familiar with Medicare regulations and provide expertise and support to the Stars program and accurate acuity scoring efforts.
- MD or DO with active, unrestricted Pennsylvania medical license plus MBA/MPH desirable
- Current board certification in ABMS recognized specialty; primary care preferred
- Minimum 5 years post-residency experience in the clinical practice of medicine, preferably with management responsibility.
- Minimum 3 years of experience in a managed care setting, preferably with responsibility for utilization management.
- Strong familiarity with Medicare, Medicare Advantage, utilization analytics and management as well as familiarity with federal regulations relating to utilization management activities is required.
- Excellent organizational, interpersonal, time management and communication skills.
- Exceptional leadership and project management skills.
- Strong conflict resolution and independent decision-making skills.
- Excellent influencing, negotiation and analytical skills.
- Knowledge of the principles of Quality and Care Management.
Tricia French, RN, BSN
President & CEO
The French Group