Physician Executive Job Opportunities
Updated April 17, 2007.

 

  • Medical Director
    Highmark Blue Shield, Camp Hill, PA
Providing over seven decades of superior service and access to quality health care, Highmark Blue Shield is the largest Pennsylvania-based health insurer in the state. We are seeking candidates for the following position in Camp Hill, PA:
 
Medical Director
This position is responsible for the following: supporting the QualityBLUE programs by providing consultation and direction for the QualityBLUE Hospital and QualityBLUE Physician programs; developing, implementing and supporting the quality improvement and provider credentialing activities of Highmark Inc. and Premiere Blue Shield by complying with all regulatory requirements and standards, achieving and maintaining all applicable accreditation standards, cooperating with other corporate departments and employees, working collaboratively with community clinicians and other providers, and using medical and business knowledge and experience; and serving as chairperson the Central Pennsylvania Region Credentials Committee to review all provider applicants and to make decisions regarding approvals, denials and/or terminations according to Highmark Credentialing Policies, Medicare Advantage requirements, and NCQA standards.
 
Required Qualifications
  • Medical degree (MD, DO)
  • Three or more years’ clinical experience.
  • Three or more year’s managerial experience, preferably with managed care or health insurance experience.
  • One year experience with designing, implementing and supporting quality improvement activities with a large healthcare organization (e.g. hospital, managed care organization, insurer, large group practice, military organization).
  • Three or more years experience communicating to varying audiences of both internal and external customers.
License or Certification Requirements
  • Valid Pennsylvania medical license
  • Current ABMS-recognized Board Certification
Other Qualifications
  • An advanced degree in management (MBA, MPH, MS, etc.) preferred.
  • Managerial experience with a managed care or health insurance company preferred.
  • Must be able to function both independently and collaboratively with others.
  • Ability to develop goals, action plans and assign responsible parties and time frames for compliance.
  • Ability to organize information, establish and communicate expectations about goals, tasks, assignments and deadlines.
  • Understands and uses the organizations’ overall business strategy to achieve goals and objectives, and uses the organizations’ structure, operations, decision-making channels, planning processor, and financial budgeting/control system to identify potential problems and opportunities.
  • Ability to effectively communicate with staff, Highmark members, healthcare providers and practitioners through written communication and oral presentations.
To submit your resume for consideration, go to our website: www.highmark.com and click on the Careers link under the About Highmark section of the site. Follow the instructions there to view our current open positions. To apply for this position, use reference #049737. Highmark, an equal employment opportunity employer, strives to capitalize on the strengths of individual differences and the advantages of an inclusive workplace.
 
  • Coventry Health Care
    Wilmington, DE
You’ve been looking for an opportunity to work with people who share your commitment to a higher standard. Good News. We’ve been looking for you, too.
 
Coventry Healthcare of Delaware has the following position available in Wilmington, DE:
 
Medical Director
PT or FT
Provides medical leadership in the health plan in order to provide excellent quality of care and service to our members that is cost efficient. Provides technical expertise in utilization management by direct decision making in the areas of pre-authorization, concurrent review, discharge planning, and complex case management. Position can be PT ( 20 hrs/wk) or FT.
 
Formal education including an MD or DO degree. Board certified with post residency experience preferably in primary care specialty. Managed care medical director experience or equivalent of at least two years. Holds an unrestricted license to practice medicine. Must maintain current state licensure. Excellent clinical knowledge and skills Strong written and verbal communications skills.
 
Please apply on line at www.chcde.com  Click on Careers then click on "On Line Career Center". Use Req #34748 for this position.  EOE
 
  • Medical Director
    Ventura County Health Care Plan
The Ventura County Health Care Plan, operating since 1994, is a full-service licensed HMO and provides health care coverage to County employees and their dependents, and to local children participating in the state-sponsored Healthy Families Program. The city of Ventura is a coastal community located 70 miles north of Los Angeles and 30 miles south of Santa Barbara. The Medical Director is responsible for medical oversight of the plan’s UM/CM/DM, and QI programs. Applicants should have a minimum of five years’ experience in medical leadership positions and significant experience in managed care organizations. The ideal candidate will have a minimum of five years’ clinical experience, five years’ experience as a medical director in a managed care setting, and must be Board certified in an ABMS recognized specialty, preferably family practice. California license is required.
 
For further information contact: Larry Keller, Health Plan Administrator at larry.keller@ventura.org
 
  • Vice President, Medical Affairs
    Austin, TX
Position Purpose:
Direct and coordinate the medical management, quality improvement and credentialing functions for the assigned business unit based on, and in support of the strategic plan, establishing the strategic vision and attendant policies and procedures.
 
Knowledge/Experience:
Requires a Medical Doctor or Doctor of Osteopathy, board certified required in a primary care specialty (Internal Medicine, Family Practice, OB/GYN, Pediatrics or Emergency Medicine). Previous experience as Medical Director is preferred. Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is desired. Experience treating or managing care for a culturally diverse population preferred.
 
Competencies:
Executive: Integrity, Flexibility, Communication, Critical Thinking, Strategic Thinking, Leadership, Ability to Execute, Business Acumen, Coaching
 
Position Responsibilities:
  • Oversees utilization management, cost containment, and medical quality improvement activities. Manages medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services. Supports effective implementation of performance improvement initiatives for capitated providers.
  • Responsible for business unit physician committees including committee structure, processes, and membership.
  • Recruits, coordinates and oversees activities of assistant medical directors and physician advisors. Recruits and utilizes the services of medical and pharmacy consultants for reviewing complex cases and medical necessity appeals. Participates in provider network development and new market expansion as appropriate.
  • Participates in the review, assessment, and negotiation of provider contracts as appropriate. Responsible for development and implementation of physician education with respect to clinical issues and company policies.
  • Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components. Identifies clinical quality improvement studies to assist the in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care. Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality. Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment.
  • Oversees and develops alliances with the provider community through the development and implementation of the medical management programs. Responsible for representing the organization before various publics both locally and nationally on medical philosophy, policies, and related issues. Participates in network development and contracting in local markets, including physician, ancillary and facility recruitment. Represents the company at the State Association Medical Directors Committee, appropriate state committees and other ad hoc committees as appropriate
License/Certificates: Board Certification through American Board Medical Specialties. Current state medical license without restrictions.
 
Please direct all inquires to Jason McBride, Human Resources Director at 512.692.1465 or email him at jmcbride@centene.
 
  • AAAHC Assistant Director - Managed Care, Accreditation Services
The Accreditation Association for Ambulatory Health Care (AAAHC) is seeking a knowledgeable expert with a thorough understanding of the healthcare environment to serve as Assistant Director-Managed Care, Accreditation Services. The AAAHC is the preeminent leader in developing standards to advance and promote patient safety, quality and value for ambulatory health care through peer-based accreditation processes, education and research. AAAHC has a staff of 35 employees who support the organization’s mission of encouraging the voluntary attainment of high-quality care in organizations providing health care services in ambulatory settings. Located in north suburban Chicago (Skokie), AAAHC currently accredits almost 3000 organizations.
 
The AAAHC is seeking an experienced professional to manage all activities related to Managed Care Organizations (MCOs) within the Accreditation Services Department. The Assistant Director-Managed Care, Accreditation Services will enhance the AAAHC market share in the accreditation of MCOs, recruit new MCO surveyors and oversee the application and scheduling activities related to MCO surveys. Responsibilities include collaborating with government relations staff to facilitate state and federal activities related to MCOs. The Assistant Director-Managed Care will also oversee the development of quality initiative activities related to MCO organizations and survey reports, in addition to working with the MCO Committee.
 
Qualifications include: baccalaureate degree (BA/BS) required, with additional health care professional credentials; Master’s degree is preferred. At least three years of recent experience in an organization, agency or business involved in MCO activities is needed. Current knowledge of health care-related quality initiative activities and processes is necessary. Demonstrated organizational and project management skills are required, along with excellent communication skills (both oral and written). The successful candidate will understand the MCO industry and the unique characteristics of the people and entities within it. Association experience is a plus. Travel is required several times a year.
 
Search conducted by Tuft & Associates, Inc. Submit resume and cover letter in confidence to Tuft & Associates, Attention: Linda Campbell, 1209 N. Astor Street, Chicago, IL 60610; telephone 773-463-5520; or e-mail to lindac@ameritech.net. Please indicate AAAHC-MCO in the subject line.
 
  • Vice President, Medical Affairs
    Indianapolis, IN
Perform duties to direct and coordinate the medical management, quality improvement and credentialing functions for the assigned health plan based on, and in support of the plan’s strategic plan, establishing the strategic vision and attendant policies and procedures.
 
Requirements
Knowledge/Experience
Requires a Medical Doctor or Doctor of Osteopathy, board certified preferable in a primary care specialty (Internal Medicine, Family Practice, OB/GYN, Pediatrics or Emergency Medicine). Previous experience as a senior HMO Medical Director is preferred. Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is desired. Experience treating or managing care for a culturally diverse population preferred.
 
Skills/Competencies
Ability to supervise others: determining or interpreting work procedures for a group of workers, assigning specific duties to them, maintaining harmonious relations among them, and promoting efficiency. Apply principles of logical or scientific thinking to define problems, collect data, establish facts, and draw valid conclusions. Deal with several abstract and concrete variables. Perform advanced functions of mathematics, algebra and statistics. Apply mathematical operations to frequency distributions, reliability and validity of tests, normal curve, analysis of variance, correlation techniques and factor analysis.
 
Accountabilities
Leadership/Supervision
Oversees or provides leadership of all of assigned health plan’s utilization management, cost containment, and medical quality improvement activities. Manages medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services. Supports effective implementation of performance improvement initiatives for capitated providers. Oversees provider credentialing.
 
Strategic Orientation
Provides expertise and vision with respect to planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for health plan members.Responsible for the implementation, maintenance, and refinement of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.
 
Significant Duties
Responsible for the functioning of the Plan’s physician committees including committee structure, processes, and membership. Recruits, coordinates and oversees activities of assistant medical directors and physician advisors. Recruits and utilizes the services of medical and pharmacy consultants for reviewing complex cases and medical necessity appeals. Participates in provider network development and new market expansion as appropriate. Participates in the review, assessment, and negotiation of provider contracts as appropriate. Responsible for development and implementation of physician education with respect to clinical issues and plan policies.
 
Quality Improvement Orientation
Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components. Identifies clinical quality improvement studies to assist the plan in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care rendered plan members. With the support of Medical Services and Provider Relations interfaces with physicians and other providers in order to facilitate implementation of recommendations to HMO providers that would improve utilization and health care quality. In conjunction with the Corporate Claims Department and Medical Review Unit, reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment.
 
Budgeting
Monitor and analyze costs and prepare departmental budget, using computer. Internal and External Communications: Oversees and develops alliances with the provider community through the development and implementation of the medical management programs, interfacing directly with the provider community regarding medical review, utilization review, and quality improvement issues and concerns. Responsible for representing the organization before various publics both locally and nationally on medical philosophy, policies, and related issues. Participates in network development and contracting in local markets, including physician, ancillary and facility recruitment. Represents the HMO at the State Association Medical Directors Committee, appropriate state committees and other ad hoc committees as appropriate.
 
Please direct all inquires to Dave Mara at 804.527.1905 or email him at dmara@namcp.org
 
  • Chief Medical Officer
    Partners Community Healthcare, Inc. (PCHI)
PCHI is a non-profit membership corporation that manages a network of more than 1150 internists, pediatricians and family practice physicians and over 4,800 specialists who provide care to more than 1.5 million patients throughout Eastern Massachusetts. Founded shortly after the creation of Partners Healthcare, an integrated health system formed by Brigham and Women’s Hospital and Massachusetts General Hospital, PCHI is seeking a physician leader who will provide clinical leadership for PCHI, provide clinical input into payor contract negotiations, and identify and lead adoption of clinical best practices for the Partners system.  The Chief Medical Officer will help Partners optimize network performance in quality, efficiency, patient safety and the patient experience. This role reports directly to the PCHI CEO, Thomas Lee, M.D. and will maintain highly collaborative relationships with PCHI and Partners leaders. National representation of Partners is a key expectation.
 
The position requires a board certified M.D., with a preference for a post graduate degree (MBA, MPH). In addition, candidates should possess a minimum of five years of clinical practice experience, and management experience in a large integrated delivery network or payor organization. Significant experience in an academic medical environment is essential.
 
Nominations or requests for additional information regarding this very influential and exciting opportunity may be obtained by contacting either Manny Berger or Kimberly Smith through the offices of Linda Komnick c/o Witt/Kieffer, 25 Burlington Mall Road, Burlington, MA 01803; phone: 847-304-8754; email: LindaK@wittkieffer.com
 
  • Medical Director, Medical Policy
Qualifications
Applicants must possess a M.D. or equivalent required with an unrestricted license to practice medicine with a minimum of 7 years clinical experience required. Must have prior detailed experience in utilization management and medical policy in a hospital or health plan setting along with a positive history of providing consultative efforts concerning medical and legal issues.
 
Direct health plan experience in medical policy development and administration is preferred. A minimum of 4 years direct health plan experience preferred. Must have Board certification in a specialty recognized by the ABMS preferred and working knowledge of the insurance industry. The position requires availability for travel and extended hours.
 
Accountabilities
The Medical Director, Medical Policy will reviews claims, serves as Medical Policy Committee Director. Reviews
Medical Underwriting consultant application, advises Provider Contracting Department and serves as consultant to
Legal Department and as a consultant to personnel, Southern National Life and administration.
 
Reviews and advises on all Care Management issues including but not limited to medical necessity for Case Management, Concurrent Review, Authorizations and Compliance Department.
 
This position reports to the Chief Medical Officer.
 
This position is at a grade level 26.
Starting Salary is $13,327.71/monthly  
Please apply online at www.bcbsla.com or contact Tanya Candler at Tanya.Candler@bcbsla.com
 
  • Medical Director
    Cincinnati and Columbus, OH
Job Summary
Oversees all medical care for Medicaid products and services. Oversees the health care needs of the membership. Serves as the principal medical manager and policy advisor to the company and health plan CEO or COO. Is accountable for and provides professional leadership and direction to the utilization/cost management and clinical quality management functions. Works collaboratively with other plan functions that interface with medical management such as provider relations, member services, benefits and claims management, etc. Assists in short and long range program planning, total quality management (quality improvement) and external relationships. Works with Corporate Health and Medical Affairs for support, assistance and direction in overall medical management effectiveness. Reports all issues of clinical quality management to the health plan CEO, COO, the Board and the Chief Medical Officer (CMO). Collaborates with the CMO and other health plan medical directors on national medical policies and carries out national medical policies at the health plan in collaboration with the health plan CEO or COO.
 
Primary Responsibilities
  • Responsible and accountable to the CEO, COO and the Board for managing the health plan’s medical costs and assuring appropriate health care delivery for the health plan’s products and services. Reports organiza- tionally to the CEO or COO of the health plan; has a dotted line relationship to the Chief Medical Officer.
  • Plans, organizes, and directs the professional medical services program, consisting of all primary and specialty services for in-patient, out-patient, preventive and wellness programs.
  • Designs and implements health plan medical policies, goals and objectives.
  • Provides professional leadership and direction to the functions within the Medical Management Department (Utilization/Cost Management and Clinical Quality Management)
  • Responsible for and assists with the development of budgets, staffing plans and medical loss ratio projections, assuring the adequate allocation of resources to the medical management functions.
  • Responsible and accountable for the Utilization/Cost Management Program and Clinical Quality Improvement Program. Performs annual evaluation of these programs and reports findings to the plan CEO, the Quality Man- agement Committee and to Corporate Medical Affairs. Develops an annual Utilization/Cost Management and Clinical Quality Improvement work plan based on the annual program evaluation and feedback from peer review committees, QA committee, Corporate Medical Affairs, the CEO and the Board.
  • Assists the CEO with activities to promote positive community relations.
  • Assures plan conformance with legal and regulatory requirements. Interacts with regulatory agencies.
  • Creates and maintains a system that gives feedback to providers individually and collectively regarding managed care effectiveness of individual providers and networks.
  • Designs and implements corrective action plans to address issues and improve plan and network managed care performance.
  • Collaborates with Corporate Medical Affairs and the health plan CEO in creating and maintaining programs that incentivize providers to achieve selected utilization/cost and quality outcomes.
  • Participates in policy review, performs analysis and makes recommendations.
  • Participates in the retrospective review and analysis of Plan performance from summary data of paid claims, encounters, authorization logs, compliant and grievance logs and other sources.
  • Achieves and maintains benchmarked utilization and cost management (UM) goals and clinical quality improve- ment (QI) objectives.
  • Supports URAC and NCQA qualification activities. Prepares for site visits and responds to accrediting and regula- tory agency feedback.
  • Supports pre-admission review, utilization management, and concurrent and retrospective review process.
  • Participates in risk management, claim adjudication, pharmacy utilization management, catastrophic case review, outreach programs, HEDIS reporting, site visit review coordination, triage, nutrition service review, provider orienta- tion, credentialing, profiling, etc.
  • Conducts quality improvement and outcomes studies as directed by the state Departments of Health, the Quality Management Committee, Medical Advisory Committee, Peer Review Committee and management. Reports findings.
  • Participates in the grievance process, insuring a fair outcome for all members.
  • Monitors member and provider satisfaction survey results and implements changes as needed to increase satis- faction and assure that satisfactory relationships are maintained between network and plan participants.
  • Establishes and reviews standards for professional and technical staffing ratios for vendors and providers to ensure their ability to deliver medical services to plan members.
  • Participates actively in provider recruitment.
  • Assists the contracting process of providers, hospitals, ancillary providers, and emergency and other support services, and evaluates the medical aspects of provider contracts.
  • Chairs (or delegates leadership of) the Medical Advisory Committees of the health plan which include (but are not limited to) the Peer Review Subcommittee and the Credentialing Subcommittee of the Quality Management Committee.
  • Participates in key marketing activities and presentations.
  • Performs and oversees in-service staff training and education of professional staff.
  • Participates in the development of strategic planning for existing and expanding business. Recommends changes in program content in concurrence with changing markets and technologies.
  • Participates in key marketing activities and presentations, as necessary, to assist the marketing effort.
  • Ensures that the Utilization Management Program is available on a 24 hour basis to respond to authorization requests for emergency and urgent services and is available, at a minimum, during normal working hours for inquiries and authorization requests for non-urgent health care services.
  • The medical director must ensure that a covered person enrolled in the Plan is permitted to:
    a. choose or change a primary care physician from among participating providers in the provider network; and
    b. when appropriate, choose a specialist from among participating network providers following an authorized referral, if required by the carrier, and subject to the ability of the specialist to accept new patients.
Education and Experience
Masters in Public Health, MBA or MA preferred.
Continuing education to remain current in medical and management areas.
Five years of clinical experience in the practice of medicine, two of which have been in medical and/or health administration.
Three to five years of management and/or clinical experience in a managed care environment.
Any equivalent combination of education and experience.
 
Certification and Licensure
Certified in a recognized medical specialty as recognized by the American Board of Medical Specialist (ABMS).
Must be licensed in Ohio as a Doctor of Medicine
Active license to practice medicine issued by the State Board of Licensure.
Certification by the American Board of Quality Assurance and Utilization Review Physicians or the American Board of Medical Management desired but not required.
 
Knowledge and Skills
Management skills to meet the organizational goals.
Must possess excellent communications skills to interface with providers, staff, and management.
Knowledge of medical, quality improvement and UM practices in a managed care environment.
Knowledge of regulatory and accreditation agencies and requirements.
Able to manage multiple priorities and deadlines in an expedient and decisive manner.
Able to manage difficult peer situations arising from medical care review.
Appreciation of cultural diversity and sensitivity towards target population.
 
Please direct all inquires to Dave Mara at 804.527.1905 or email him at dmara@namcp.org
 
  • Medical Director
    Austin, Texas
Assist the Vice President of Medical Affairs to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit.
 
Knowledge/Experience
Requires a Medical Doctor or Doctor of Osteopathy, board certified preferable in a primary care specialty (Internal Medicine, Family Practice, OB/GYN, Pediatrics or Emergency Medicine). Previous experience within a managed care organization is preferred. Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is preferred. Experience treating or managing care for a culturally diverse population preferred.
 
Competencies
Manager: Integrity, Flexibility, Communication, Critical Thinking, Building a Successful Team, Decision Making, Planning and Organizing, Building Strategic Working Relationships, Technical and Professional Knowledge
 
Responsibilities
  • Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services. Supports effective implementation of performance improvement initiatives for capitated providers.
  • Assists VPMA in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members. Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.
  • Assists the VPMA in the functioning of the physician committees including committee structure, processes, and membership. Oversees the activities of physician advisors. Utilizes the services of medical and pharmacy consultants for reviewing complex cases and medical necessity appeals. Participates in provider network development and new market expansion as appropriate. Assists in the development and implementation of physician education with respect to clinical issues and policies.
  • Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components. Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care. Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality. Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment.
  • Develops alliances with the provider community through the development and implementation of the medical management programs. As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues. Represents the business unit at appropriate state committees and other ad hoc committees
License/Certifications
Board Certification through American Board Medical Specialties
 
Please direct all inquires to Dave Mara at 804.527.1905 or email him at dmara@namcp.org

 

If you have interest in learning about additional opportunities or have an available position, please contact Sloane Reed at (804)527-1905 or email your CV/Resume to sreed@namcp.org  Confidentiality will be maintained at all times.