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
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
Excellent organizational, interpersonal, time management and
Exceptional leadership and project management skills.
Strong conflict resolution and independent decision-making
Excellent influencing, negotiation and analytical skills.
Knowledge of the principles of Quality and Care Management.