Serves as Medical Director of Care Center.
Responsible for working with call center management and staff to assure high clinical quality programs are delivered to health plan members.
Candidate will lead clinical rounds to address individual patient considerations including level of intervention, provider communications and potential issues.
Participates in leading the strategic implementation of programs to improve the health of the people we serve. Influences product strategy and design and medical management approaches that impact health care quality cost and outcomes.
Improves access to and usefulness of health improvement tools offered to health plan members.

Monitors competitor products and internal medical management capabilities and responds with recommendation for improvement in models.
Contributes to development of Care Management and Quality Management strategies.
Responsible for consistent adoption, implementation and coordination of all medical policy in programs.
Provides clinical leadership for Case management, Disease Management and, Quality Management in cooperation with Regional team and Chief Medical Officer.
Provides medical expertise in sales planning and participates in the acquisition and retention of accounts.
Assures the medical relevance of account reporting regarding use of medical services for health plan members.
Communicates program components and outcomes in a concise and confident manner.
Position focus is Disease Management.
Responsible to provide day to day guidance, support, and leadership for the clinical and quality activities and support the Medical Director in ensuring the clinical integrity of broad and significant clinical programs.

Primary duties may include, but are not limited to:
Provides support to clinicians in daily tasks and participates in peer-to-peer discussions and office visits with providers and external physicians as necessary.
May participate in a physician on-call rotation for a 24x7 pre-certification unit.
Assists in the practitioner appeal reviews, appropriateness criteria reviews, medical policy and technology assessments, setting and implementing QI initiatives, and practitioner/provider credentialing.

Qualifications:
M.D. required. Ten years of healthcare experience with extensive managed care and disease management knowledge. This includes in-depth experience with population health management, wellness, prevention, and healthy lifestyles. Experience with large employers and product design to meet the needs of sophisticated employers would be an asset.. Strong understanding of health management with demonstrated ability to influence members' health behaviors. Advanced written and oral communication skills including excellent presentation skills, and exceptional relationship building skills required. Demonstrated strategic thinking and planning, and implementation skills required. Ability to work in a complex, matrixed organization.  Position will require some travel.