Broadlyresponsible forsupporting the medical and surgical division mission, vision, products and strategies of the company’s commercial business units. Provides broad clinical leadership to the areas of product development and innovation,sales and account management, quality management, medical policy and clinical guidelines and oversight ofclinical operations. Works collaboratively with the senior leadership throughout the company but specifically in medical, quality, operations, product, account management andsales, to achieve overall company goals.Responsible for clinical oversight of medical policy and formulary management, and leads the development of clinical programs for the division.Responsible for directing and leading clinical strategy,utilization management strategy and outcomes, and quality improvements of all aspects of medical and surgical operations. Provides overall strategic direction and oversight of national comprehensive medical policy and programs to include contributions to the development, implementation and evaluation of the clinical and cost effectiveness of medical services. Provides collaborativesupport for the seniorsales team includingsales with on-site meetingsupport, clinical oversight and collaborativesupport of the account management, clinical direction, cost of care and quality improvement for managed care business.Responsible for clinicalsupport to business development includingstrategic initiatives to grow the company’s Medical-Surgical business and participates in innovation and product development. Provides tactical leadership and participates on teams whichrespond to prospective clientRFIs andRFPs, and providers strategic thought leadership to new products that will differentiate the company across all payers in the marketplace. Leverages physician subject matter experts as needed to develop while providing medical and surgery clinical leadership to the national clinical quality program and medical policy and clinical guidelines development for the medical-surgical business unit including radiology, cardiology, physical medicine, musculoskeletal and radiation oncology.
Masters, MD (Required)
License and Certifications - Required
DO - Physician, State Licensure and Board Certified (ABMS or Specialty Board) - Physician, MD - Physician, State Licensure and Board Certified (ABMSor Specialty Board) - Physician
License and Certifications - Preferred
Other Job Requirements
Masters degree in a health related field.
Experience managing other physicians is strongly desired., Must have managed care leadership experience as a medical director including experience with government products (Medicare and Medicaid).
Must have experience with provider delivery system transformation.
Deep managed care and public sector experience required.
Must understand the healthcare delivery system, specifically Medical Surgical benefit management in all payer areas including Specialty, Employer, MCO, Medicaid and Medicare., business models and network contracting.
Broad knowledge of health plan operations includingutilization, population health, disease management and care management, HEDIS and Stars,riskproducts and benefit design.