Responsible for coordination of medical policy, peer review, quality management, legal/medical issues, and the effectiveness of the Medical Management Program. Time will be split between the HealthSpring of Tennessee Health Plan and the Part D Plan.

Directs the medical policy for a single-market health plan and the Medicare prescription drug plan. Establishes and implements policies and standards, evaluates new treatments, and conducts medical research to ensure the quality of the medical care provided to patients for a single-market health plan. May assist in sales presentations or provider recruitment and retention.  Responsible for chairing appropriate pharmacy committees, providing leadership for pharmacy and health services utilization management projects, and assisting in the development and maintenance of coordinated pharmacy-medical management projects.  Provides support and guidance for appeals, medication prior-authorization requests, and benefit designs and levels. Develops and maintains partnerships across departments within the division.  Responsible for successfully managing a high member to medical director ratio.

Minimum Requirements:  Degree in medicine from an accredited school and is licensed to practice medicine (Doctor of Medicine or Doctor of Osteopathic Medicine).  At least two years of clinical experience in a managed care organization.  Pharmacy experience.  Ability to be hands on, adaptable, focused, flexible, data driven, results-oriented, and a high performer.  Good communication skills.

Preferred Requirements:  Proven analytical skills. Experience with gap coverange programs.

HealthSpring, Inc. is an EEO/AA employer.