Associate Medical Director

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

Benefits offered by this job

Annual Incentive Bonus

401(k) with employer match

PTO

Health benefits and wellness programs

Job summary

Blue Cross and Blue Shield of North Carolina is seeking a Medical Director to guide clinical strategy and collaborate with physicians, providers, employers and members. The role focuses on value-based care, quality initiatives and cost-effective outcomes in a dynamic health care organization.

The Medical Director will lead cross-functional teams, shape clinical operations, and engage with external partners on performance improvement, data-driven decisions and regulatory alignment.

Qualifications

• MD or DO with residency completed and board certification.
• Experience in leadership and healthcare program design.
• Clinical knowledge aligned with value-based care goals.

Responsibilities

• Lead clinical strategy and interface with physicians, providers and members.
• Drive value-based care initiatives and quality improvement.
• Develop and implement care management and utilization strategies.
• Collaborate on market and partnership opportunities with internal and external partners.
• Analyze data to identify clinical and financial improvement opportunities.

Skills

Clinical Experience

Clinical Leadership

Health Care

Health Care Compliance

Healthcare Development

Healthcare Improvement

Healthcare Transformation

Medical Care

Medical Decision Making

Medical Knowledge

Medical Quality

New Program Development

Patient Care

Patient Care Coordination

Patient Evaluations

Policy Development

Education

MD or DO from an accredited medical school

Residency training program completed

Board certification in ABMS/AOA recognized specialty

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 an

• Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and 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 Transformation, Medical Care, Medical Decision Making, Medical Knowledge, Medical Quality, New Program Development, Patient Care, Patient Care Coordination, Patient Evaluations, Policy Development

About Us

It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians. Blue Cross NC is a fully taxed, not‑for‑profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all. Help us lead the charge for better health care by joining our award‑winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.

Authorization to Work in the United States

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Request Accommodations

Blue Cross NC provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application, hiring process, or have technical issues that prevent you from completing your application please notify HR at [e-mail]. Blue Cross NC is a Hybrid Flex company. Whether the role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any of our approved states: Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming