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The Medical Director of Provider and Client Health Care Solutions is a unique position, which creates a channel through which the health plan can communicate with our clients, provider community, organized medicine and market/community leaders. The Medical Director supports the Delivery System by educating the key physician and provider community on programs and strategies. Additionally, the Medical Director provides Sales support by presenting the clinical value proposition to current and prospective clients, participating in finalist presentations and delivering clinical data and outcomes to current clients. This position will interact and co-ordinate with the sales team, brokers and consultants. This role informs the Marketing organization of business intelligence from relevant customer, provider, and community segments. This position also teams with Sales for sales activities and product roll-outs. Additionally, this position will interface with clinical providers supporting clinical and quality programs. Through these programs, results of quality, cost, outcomes, and overall performance will be presented to providers. The Medical Director will work with providers to discuss results and offer solutions for improvement of these standards and metrics.
The Medical Director reports to the Senior Medical Director, a seasoned and immensely respected physician executive with a calm demeanor and approachable, team-oriented management style.


-Regularly support and attend county medical society meetings and participate on committees as appropriate.
-Develop and maintain relationships with key influencers in the local market, primarily physicians in the network, hospital administrators, and medical staff leaders.
-Facilitate local market physician advisory panel in order to enhance communications, relationships, policy and program development, and field testing. Support resolution of local care and network issues as identified (e.g., variability).
-Work with Network and Informatics in refining provider specific profiles.
-Support credentialing process as needed.

-Provide support to account managers/sales reps on account presentations, problem solving and information sessions with brokers and/or key accounts.
-Meet with select groups to provide consultative clinical strategic solutions.
-Serve as key presenter and educator for high profile wellness events and media events with a clinical focus.
-As local medical spokesperson, inform and educate marketplace on policy, strategy, clinical value proposition and programs.
-Monitor and understand future medical models and national trends in our industry.

-As member of local market leadership team, provide intelligence and insights on network management issues and market strategy.
-Build relationships with local market leadership. Participate on local market committees.
-Maintain and develop knowledge and information on local delivery system and market through reading of local periodicals and confirmation with key provider relations.
-Interact routinely with Care Management medical directors to gather information on network physicians requiring \ education\ or alignment, current clincial issues and trends and inform local delivery system as appropriate.
-Develop and maintain relationship with key hospital executives as requested by Network and other divisions and speak as appropriate as representative from the health care industry from the payer side.
-Participate with community giving programs to influence and focus contributions and assist in presentation.

-Meet with targeted physicians to share performance data cost, use and quality; and support alternative care delivery models such as PCMH.
-Support local physician advisory committees as necessary.
-Facilitate resolution of issues between Care Management and local delivery system, accounts, agents and members.
-Particiapte in general medical director activities including participating in cfredentialing appeals committee, medical policy and grievance and appeals as deemed necessary.

-M.D. or D.O. from an accredited medical school with active, unrestricted medical license
-Current Board Certification in an ABMS recognized speciality-primary care preferred
-Minimum 5 years clincial experience with 3-5 years experience as a medical director in a managed care/health care company
-Ability to provide medical knowledge to facilitate resolution of complex issues and required decisions
-Knowledge of medical economics and performance reporting methods
-Excellent written and verbal communication and presentation skills
-Broad and deep understanding of healthcare delivery systems and market dynamics
-Working knowledge of sales and marketing disciplines and ability to apply these to the medical delivery system
-Must be able to work hours congruent with providers – including evening meetings
-MBA, MPH, MHS, MHA, etc. preferred

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