Medical Director

Hanover; Omaha (NE); On-site; USD 190,000 - 270,000; Full time

Job summary

Blue Cross and Blue Shield of Nebraska (BCBSNE) seeks a Medicare Medical Director to drive clinical quality, care management, and population health outcomes for the Medicare population. The role leads strategies to transform practice patterns, improve patient satisfaction, and reduce overall costs.

Responsibilities include guiding utilization review, engaging clinicians, and collaborating with internal teams to advance quality initiatives across primary and specialty care.

Qualifications

• MD or DO with unrestricted US medical license.
• Board certification by ABMS.
• 7+ years direct clinical experience with quality improvement and population health.
• 2+ years managed care experience, preferably Medicare Advantage.

Responsibilities

• Oversee clinical, quality, care management, and population health outcomes and cost for the Medicare population.
• Assess opportunities within the Medicare population for changes or new programs.
• Lead clinical engagement to drive quality and care management in primary and specialty care settings.
• Improve provider documentation and risk adjustment to ensure quality care.
• Develop relationships with physicians to disseminate best practices and improve workflows.
• Collaborate with partners to optimize quality initiatives across the Medicare population.
• Serve as lead liaison to network providers and facilities for Medicare services.
• Provide alternative approaches to improve practice performance with quality.
• Develop strategic relationships with internal and external stakeholders involved with Medicare care.

Skills

Utilization review

Quality assurance

Direct case management

Stakeholder buy-in

Clinical training (residency)

Education

MD/DO

ABMS board certification

Unrestricted US medical license

Job description

Blue Cross and Blue Shield of Nebraska (BCBSNE) Overview

BCBSNE has provided healthcare coverage and peace of mind to Nebraskans for more than 85 years, offering group health, individual plans, dental, and Medicare solutions. As part of a nationwide association, the Blue Cross and Blue Shield brand represents the nation's largest and most experienced healthcare benefit companies, serving 600,000+ people in Nebraska. The organization serves members locally through extensive provider networks and nationally through the BlueCard program.

Role Summary

The Medicare Medical Director is responsible for clinical, quality, care management, and population health outcomes and cost for the Medicare population. The Medical Director will lead development and implementation of strategies that promote practice transformation, patient satisfaction, improve quality and outccoms, while reduce overall cost for a Medicare Advantage population.

Key Outcome / Responsibilities:

• Oversight of clinical, quality, care management, and population health outcomes and cost for the Medicare population
• Assess areas of greatest opportunity within the Medicare population and identify areas for potential changes, enhancements, or new programs
• Lead clinical engagement in assigned market(s), partnering with the Chief Medical Officer to drive quality and care management performance improvement in primary and specialty care settings
• Improve provider clinical documentation or burden of illness capture (Risk Adjustment) to ensure best clinical care of members/patients
• Develop relationships with physicians and staff to engage, identify, and disseminate best practices, analyze clinical workflows, and support intervention activities directed towards meaningful quality improvements and reduction of unplanned health care utilization
• Collaborate with key organizational partners and their teams to optimize quality and clinical initiatives and drive improvements across the Medicare population
• Act as lead business and clinical liaison to network providers and facilities to support the effective execution of Medicare medical services programs
• Provide alternative approaches that can improve practice performance while achieving similar or greater clinical quality
• Develop and maintain strategic relationships with internal and external stakeholders involved with the care and management of the Medicare population

Specific Skills, Knowledge & Capabilities:

• Experience with utilization review/quality assurance, and direct case management
• Demonstrated skills in creating buy-in with internal and external clinician stakeholders to transform clinical care
• Additional Training: preferred residency in an adult primary care specialty (family medicine, general internal medicine, geriatric medicine, combined internal medicine/peds)

Qualifications Required:

• Doctor of Medicine (M.D or D.O)
• Board Certified in an American Board of Medical Specialties Board, and a current, unrestricted license to practice medicine in a state or territory of the United States, including post graduate direct patient care experience required
• 7+ years of direct clinical (patient care) experience, with consideration given to quality improvement activities, participation in cost containment initiatives and other population health experiences
• 2+ years of managed care experience, preferably with a Medicare Advantage population