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Medical Director, Health Alliance

Carle Health is seeking an experienced physician executive to serve as Medical Director for Health Alliance in Champaign, Illinois.

This is an outstanding opportunity to join an expanding health plan within Carle Health, one of the region's leading integrated healthcare delivery systems. Health Alliance is a growing physician led health plan serving Illinois, Iowa, Indiana, Ohio, North Carolina and the state of Washington with over 240,000 members. Health Alliance is committed to value and the promotion of progressive care models to deliver excellent patient care outcomes to its members. With a proven customer-driven performance reputation, Health Alliance rated 4/5 Stars nationally for our Medicare Advantage HMO/POS plan in Illinois and 5/5 Stars for our Stand Alone Prescription Drug Plan.

The Medical Director is a vital member of health plan operations and leadership team.

The Medical Director will report directly to the ACMO, Health Alliance. This position is primarily focused on utilization management, provider engagement and data analytics, for Health Alliance. The Medical Director will possess outstanding interpersonal skills with the ability to communicate effectively and build consensus to achieve objectives. The Medical Director will participate, as directed by the ACMO, in operationalizing the Health Alliance strategic plan.

Candidate Qualifications:

M.D. or D.O. from accredited medical school. Board certified and holds active IL license
Physician leadership coursework or Master's degree in Business, Health Administration, or Public Administration is recommended
Experience working on committees
This position will be based out of Champaign, Illinois with the opportunity to do some work remotely

Knowledge and experience with health plans including utilization management, policy and claim review, and deep understanding and interest in medical economics and data analysis
Results oriented with demonstrated ability to develop and operationalize policies across health plan to improve performance and workflow
Strong understanding and experience examining appeals and case reviews for claim denials that promote consistency across organization
Engage key internal stakeholders to review processes and ensure coordination across health plan
Ensure application of best practices, incorporating regulatory requirements at local, state and national level
Ability to function effectively and comfortably in a matrix environment in which there are multiple collaborative organizations with shared goals within complex lines of authority and responsibility
Familiarity and passion for analytics as it relates to utilization management, cost analysis, population health management and impact of data in continuous assessment and monitoring that strives to improve care and service provided to members
Ability to utilize clinical patient care practice experience to examine complex member issues and challenges
Excellent listener and communicator with demonstrated track-record in fostering collaboration and building consensus to achieve collective objectives
An open and accessible style, is calm and thoughtful, encourages input from the team. A consensus builder with superb facilitation skills, a team player who is collaborative and possess the highest level of integrity

About Carle:
Based in Urbana, IL, The Carle Foundation is a vertically integrated system with more than 9,500 employees in its five hospitals, multi-specialty physician groups, health plan and associated healthcare businesses including the Carle Illinois College of Medicine, the world’s first engineering-based medical school. Carle is proud to be named a Great Place to Work®. Carle Foundation Hospital and Carle BroMenn Medical Center hold Magnet® designation, the nation’s highest honor for nursing care and Carle Foundation Hospital (CFH) ranks as one of America’s 50 Best Hospitals™ by Healthgrades®.

Time:  Full time
Salary:  Salary
Category:  Administration

Updated: 10/22/2021 4:57:39 PM

Job Contact:
Reyna Lute

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3310 Fields South Drive
Champaign, IL 61822