Plan Performance Medical Director- Wisconsin and Missouri Markets

Plan Performance Medical Director- Wisconsin and Missouri Markets

Plan Performance Medical Director- Wisconsin and Missouri Markets

Location: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Candidates must live near the St. Louis location.

The Plan Performance Medical Director (PPMD) is a trusted clinical partner for the WI and MO markets. The PPMD will support sales teams to grow and retain business. PPMDs represent our population health strategy in our communities and build provider partnerships and local government relationships as well as respond to new regulations and other market concerns. The PPMD is a critical member of the market leadership team, advising and collaborating with the Plan President, Network teams, and other functions to improve both affordability and member and provider experience. PPMDs assess local trends in utilization and develop and implement Cost of Care initiatives.

How you will make an impact:

• Leads, develops, directs and implements clinical and non-clinical activities that impact efficient and effective care
• Supports new and existing customers by delivering clinical insights and recommendations that enhance the value-proposition of clinical programs
• Identifies and develops opportunities for innovation to increase effectiveness and quality
• Provides expertise; captures and shares best practices across regions
• Provides guidance for clinical operational aspects of a program
• Interprets existing policies or clinical guidelines and supports new policies based on changes in the healthcare or medical arena
• Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations
• May chair or serve on company committees, may be required to represent the company to external entities and/or serve on external committees

Minimum Qualifications:

• Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
• Requires active unrestricted medical license to practice medicine or a health profession.
• Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.
• Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

• Leadership activities in care or utilization management preferred.
• Managed care or population health management experience strongly preferred.

Job Level: Director Equivalent

Workshift: 1st Shift (United States of America)

Job Family: MED > Licensed Physician/Doctor/Dentist