Associate Medical Director

Blue Cross and Blue Shield of North Carolina; Kentucky; On-site; USD 191,000 - 306,000; Full time

Benefits offered by this job

Annual Incentive Bonus

401(k) with employer match

Paid Time Off (PTO)

Health benefits and wellness programs

Job summary

Blue Cross NC, a leading health plan, seeks a Medical Director to drive value-based strategies and clinical operations. The role interfaces with physicians, providers, employers and members to advance high-quality, cost-effective care.

The position requires MD/DO, NC license, and ABMS/AOA board certification, with 5+ years of relevant experience and leadership capability in healthcare programs and policy development.

Qualifications

• MD or DO from an accredited medical school and completion of residency training program.
• 5+ years of experience in related field
• Current North Carolina medical license
• Board certification in ABMS/AOA recognized clinical specialty is required

Responsibilities

• Lead strategy for value-based care initiatives and care delivery improvements.
• Oversee medical reimbursement and policy.
• Manage care programs including disease management and utilization management.
• Develop strategic partnerships with providers, health systems and external partners.
• Engage with data to identify opportunities for improvement in health outcomes and cost.
• Represent BCNC in external meetings and advisory groups.

Skills

Clinical Leadership

Healthcare Management

Medical Decision Making

Policy Development

Quality Improvement

Data Analysis

Education

MD or DO from an accredited medical school

Job description

Job Description

The Medical Director brings a unique set of knowledge and skills to the business of Blue Cross North Carolina and frequently serves as an interface between the company and physicians, providers, employer and community groups, and members as needed. Utilizes clinical knowledge and experience to support value-based strategies, clinical operations and our organizational pursuit of high quality and cost-effective care for members.

The application of a Medical Director's knowledge and clinical skills will vary across the Health Care division, dependent on focus areas identified by the business area supported.

Leadership Skills

• Project planning and management

Core Skills

• Strategy
  • Develops, collaborates and/or drives strategy and approach for varied Health Care and/or organizational initiatives (i.e. sales management strategies, behavioral health strategies, new health care delivery strategies)

• Operations
  • Medical reimbursement and policy
  • Care management (utilization management, case management, PA, appeals)
  • Healthcare programs (disease management, Moonshots)
  • Network support (Credentialing)
  • Quality model design and analysis

• Partnership
  • Develop strategic partnerships with internal business partners and external clients to support value-based agreements and drive better consumer and provider experience.
  • Takes a lead role in outreach and relationship building across the community (i.e. providers, health systems, community partners, members, etc).
  • Evaluate and manage new and/or existing vendors and solution partners to align to BCNC's strategic direction
  • Ongoing provider engagement functions

• Data gathering, management and analysis
  • Evaluate clinical and other data to identify opportunities for improvement in health outcomes and financial performance
  • Discuss data and performance with providers, employers, accreditors and regulators as needed.

• Communications
  • Represent BCNC through delivery of presentations, speaking engagements and leadership of advisory groups with external audiences related to health care transformation and BCNC's initiatives.
  • Publish high impact content focused on improving accessibility, quality and affordability.

• Innovation
  • Payment model design
  • Identify market trends that should influence key investments (new technologies, best practices).
  • Evaluation of investment/partnership opportunities

Hiring Requirements

• MD or DO from an accredited medical school and completion of residency training program.
• 5+ years of experience in related field
• Current North Carolina medical license
• Board certification in ABMS/AOA recognized clinical specialty is required

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes:

• Annual Incentive Bonus*
• 401(k) with employer match
• Paid Time Off (PTO)
• competitive health benefits and wellness programs

*Based on annual corporate goal achievement and individual performance.

$191,153.00 - $305,845.00

Skills

Clinical Experience, Clinical Leadership, Health Care, Health Care Compliance, Healthcare Development, Healthcare Improvement, Healthcare Management, Healthcare Transformation, Medical Care, Medical Decision Making, Medical Knowledge, Medical Quality, New Program Development, Patient Care, Patient Care Coordination, Patient Evaluations, Policy Development

_____________________________________________________________________