Market Medical Officer, Central
Core
Clinical executive for the Central region partnering with P&L leadership to drive market performance, expand care access, and optimize medical cost trends.
Role type
Senior clinical market leader (health insurance)
Builds
Regional clinical initiatives, provider alignment strategies, and equitable care access programs
Domain
Health insurance / Managed care
Required skills
Strategic partnership building, clinical trend management, network gap resolution, regulatory compliance, team leadership, appeals management
Preferred skills
P&L experience for risk-bearing entities, multi-state licensure, utilization management experience, advanced degree
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