Medical Director, Provider Network Management

  Geisinger Health Plan (GHP) is seeking a physician leader, board-certified in family medicine, emergency medicine, or internal medicine, to act as Medical Director, Provider Network Management, working 80% with GHP and 20% in clinical practice. This position will report directly to the Health Plan Chief Medical Officer.   

About the position:

·         Partner with Provider Network Management Department to engage GHP’s network physicians to improve the health of member through enhanced member experience, quality of care, and efficient use of resources.

·         Work closely with all Health Plan Medical Directors to further GHP’s goals.

·         Provide guidance and interpretation on issues of medical appropriateness, benefit application, and level of care necessary as needed to assist in answering questions, queries and appropriateness from providers.

·         Participate in Medical Director On-Call and On-Duty and Appeals Committee activities as necessary.

 

The ideal candidate will have 3-5 years of clinical experience with previous experience as a medical director in a managed care organization, desirable. Dedication to the philosophy of managed care and continuous quality improvement of clinical care and services, is a must.

 

Geisinger Health Plan (GHP) is the health insurance component of Geisinger Health System and serves over 460,000 members in Pennsylvania and New Jersey. Begun in 1985, GHP provides high quality, affordable health-care benefits for businesses of all sizes, individuals and families, and Medicare beneficiaries*.

*PPO and high deductible plans are sold through Geisinger Quality Options, Inc. Self-funded plans are sold through Geisinger Indemnity Insurance Company.

 

For more information, please visit geisinger.org/careers or contact: Miranda Grace, Talent Management Consultant, 717-242-7109 or mlgrace@geisinger.edu