Market Medical Officer, Atlantic
Core
Clinical executive for the Atlantic region partnering with P&L leadership to lead market performance, expand care access, and enhance affordability.
Role type
Senior clinical executive (Market Medical Officer)
Builds
Regional clinical programs, provider alignment strategies, and equitable care access initiatives
Domain
Health insurance / Managed care / Clinical Affairs
Required skills
Strategic partnership building, clinical trend management, utilization optimization, regulatory compliance, team leadership, network gap resolution, appeals management
Preferred skills
P&L experience for risk-bearing entities, multi-state licensure, advanced degrees, utilization management experience
Technologies
None stated
Responsibilities
Drive performance of key clinical metrics (ED/K, APK, ALOS) in partnership with market P&L leadership; Identify market-based utilization trends and develop solutions to reduce overall spend; Build strategic partnerships with health systems and physician groups to align incentives; Serve as regional clinical partner across internal teams (Affordability, UM, CM, Claims); Partner with Network Contracting to enhance provider alignment and care quality; Proactively identify and resolve regional network gaps and access barriers; Collaborate with regulatory agencies to ensure network adequacy and quality compliance; Serve as point of accountability for regional escalations including appeals and grievances
Seniority
Senior, hands-on IC with leadership mandate