• Provide medical oversight, expertise and leadership to ensure the delivery of cost effective, quality healthcare services to health plan members • Serves as clinical advisor to and educator of medical management staff making sure correct clinical judgment is applied to all medical management determinations • Provide leadership and expertise in the development, implementation and interpretation of medical review and quality related policies and guidelines • Provide oversight and direction for staff and provider training and education • Promote positive relations with the local medical community, including periodic consultation with providers or prescribers • Review case management data, identifies trends and gaps in care and recommends corrective actions • Review all quality of care issues and oversees the development and implementation of processes for improvement • Monitor performance indicators to ensure the delivery of cost-effective care within quality standards • Monitor member and provider satisfaction and recommends and implements changes to improve satisfaction levels • Work collaboratively to develop corporate clinical care standards and medical practice policies • Provide medical guidance to the Medical Management department