Medicare Medical Director

Blue Cross and Blue Shield of Nebraska; Nebraska; Hybrid; USD 210,000 - 320,000; Full time

Job summary

A healthcare organization in Nebraska seeks a Medicare Medical Director responsible for overseeing clinical and quality outcomes for the Medicare population. The ideal candidate will hold an MD or DO, be board-certified, and possess extensive direct clinical experience and managed care knowledge. Candidates must be willing to engage with the community while delivering quality care and improving patient satisfaction. This role includes a commitment to excellence in healthcare delivery and is pivotal for transforming Medicare services.

Qualifications

• Must have a current, unrestricted license to practice medicine in the US.
• Seven years of direct clinical experience, including quality improvement activities.
• Two years of managed care experience with a Medicare Advantage population.
• Two (2) years of managed care experience, preferably with a Medicare Advantage population.
• Ability to travel to on-site practices.

Responsibilities

• Oversee clinical, quality, care management, and population health outcomes for Medicare.
• Lead development and implementation of practice transformation strategies.
• Collaborate with stakeholders to drive improvements in quality and clinical initiatives.
• Improve provider clinical documentation to ensure better clinical care of members/patients.
• Develop relationships with physicians and staff to disseminate best practices and support intervention activities.
• Collaborate with organizational partners to optimize quality and clinical initiatives across the Medicare population.
• Act as lead business and clinical liaison to network providers and facilities for Medicare medical services programs.
• Provide alternative approaches to improve practice performance while maintaining clinical quality.
• Develop and maintain strategic relationships with internal and external stakeholders involved in Medicare care.

Skills

Clinical oversight of Medicare population

Quality improvement initiatives

Managed care experience

Stakeholder relationship management

Education

Doctor of Medicine (M.D or D.O)

Board certification in American Board of Medical Specialties

Job description

At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve.

Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there’s no greater time for forward-thinking professionals like you to join us in delivering on it! As a member of Team Blue, you’ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.

Candidates applying to this position must live within driving distance of the Omaha, Nebraska metro. This position will require 2-3 days per week in the office.

The Medicare Medical Director is responsible for clinical, quality, care management, 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 outcomes, while reducing overall cost for a Medicare Advantage population.

What You’ll Do

• 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 better 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

To Be Considered For This Position, You Must Have

• 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
• Seven (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.
• Two (2) years of managed care experience, preferably with a Medicare Advantage population
• Ability to travel to on-site practices

An equivalent combination of education and experience may be substituted for this requirement. The ability to meet or exceed the attendance and timeliness requirements of their departments.

The ability to work well in a team environment and be capable of building and maintaining positive relationships with other staff, departments, and customers.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and or ability required.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned.

The Strongest Candidates For This Position Will Also Possess

• 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)

Learn more about what makes BCBSNE such an exceptional place to work by visiting NebraskaBlue.com/Careers.

We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.