Medical Officer

• Serve as the clinical executive for the Atlantic region
• Partner with P&L leadership to lead market performance, expand care access, and enhance affordability
• Optimize medical cost trends and reimbursement strategies
• Execute regional programs and bridge corporate operations with local provider leadership
• Drive key clinical metrics for trend management and regional plan performance
• Identify utilization trends and develop solutions to reduce overall spend
• Build partnerships with health systems, physician groups, and community providers
• Partner with Affordability, Utilization Management, Care Management, Claims, and other internal teams
• Guide clinical initiatives that enhance provider alignment, care quality, and clinical outcomes
• Resolve network gaps and access barriers
• Collaborate with regulatory agencies and compliance teams on network adequacy and quality programs
• Translate policy changes into operational strategy
• Own regional escalations, appeals, grievances, and complex case management scenarios
• Report to the Vice President, Clinical Affairs

Market Medical Officer

• Drive performance of key clinical metrics for regional trend management and market performance
• Partner with Medical Economics to identify utilization trends and develop solutions to reduce overall spend
• Build strategic partnerships with health systems, physician groups, and community providers
• Serve as regional clinical partner with Affordability, Utilization Management, Care Management, Claims, and other internal teams
• Guide clinical initiatives with Network Contracting leadership to enhance provider alignment, care quality, and clinical outcomes
• Identify and resolve regional network gaps and access barriers
• Collaborate with regulatory agencies and compliance teams on network adequacy and quality programs
• Translate policy changes into operational strategy protecting member access and organizational performance
• Own regional escalations, including appeals, grievances, and complex case management scenarios
• Report to the VP of Clinical Affairs
• Perform other responsibilities as assigned