This is a newly created, highly visible role for a seasoned physician executive with a passion for making a difference within the Medicare population. The Senior Medical Director – Medicare Medical Trend Management is responsible for national leadership of strategic medical management activities which contribute to the performance of the markets and promote quality of care.

The position will establish and drive medical trend management strategies nationally in collaboration with, among other areas, Medical Economics, Informatics and National Care Management. In addition, responsibilities include clinical leadership for the development and implementation of medical programs/policies, enhancing relationships with providers and facilities, plan sponsors and regulatory agencies as needed to support state specific medical management requirements and acts as a key business partner in strategic planning, network development, and product design.

This position can be based remotely as long as accessible to an airport as travel to the markets on a regular basis is required. The Senior Medical Director reports to the Medicare CMO who is an energetic, seasoned and well-respected physician executive with a business mind and proponent of staff development.

In this position you will:
• Provide clinical and business leadership in support of strategic business objectives at the national level of the business unit.
• Be responsible for the development and leadership of medical utilization and cost trend management strategies and solutions in collaboration with local health plan leaders for each market.
• Use data analysis to identify opportunities for medical cost trend and quality improvement and to positively influence practice patterns, plan sponsor trends or benefit plan designs.
• Develop and improve tools to support medical cost management programs.
• Promote quality and medical appropriateness of care.
• Have responsibility for multiple medical management initiatives and achievement of desired performance.
• Responsible for leadership of medical management activities that meet the strategic needs of business segments and plan sponsors.
• Participate in evaluation of product design; impact on quality, care and service.
• Participate in short and long range program planning, total quality management and external relationships.
• Be responsible for the design and implementation of medical policies, goals and objectives.
• Provide professional leadership and direction to the functions within National Care Management.
• Participate in the development of strategic planning for existing and expanding business.
• Work collaboratively with other functional areas that interface with National Care Management including provider relations, member services, sales, benefits and claims management, health care delivery, national medical services and national accounts.
• Act as critical medical leader for external providers and plan sponsors, including regulatory & accrediting agencies, and healthcare community in general.
• Lead in improving and maintaining positive relations with providers, facilities, customers and consultants.
• Support sales and marketing efforts including participation in key marketing activities and presentations.
• Act as a key business partner in network development strategy, to maintain member access to high quality medical care.
• Operate as the key contributor in the development, maintenance and support of a marketable, high quality provider network.
• Participate in the development, implementation, maintenance and support of designated provider contracts.

A significant focus of the role is mentoring Senior Medical Directors across the enterprise and other local medical directors. There may also be the potential to lead team(s) within Medicare Medical Operations.

• 5+ years of experience in the health care delivery system required with 5+ years additional leadership and management experience in the health care industry including Medicare.
• Demonstrated ability to make strategic decisions based on a thorough understanding of industry issues, trends and the regulatory landscape.
• Demonstrated ability to create business strategy to drive competitive advantage and shift direction as market conditions dictate.
• Demonstrated ability to interact successfully with external providers.

• M.D. or D.O. with active and current state medical license without encumbrances.
• Advanced degree in business or public health desirable.
• Current Board Certification in a recognized specialty (Family Medicine, Internal Medicine preferred)


For additional information and/or confidential consideration, please contact:

CONSULTANT: Tricia French, RN, BSN
President & CEO
The French Group