Medicare Medical Director

Blue Cross Blue Shield of Nebraska; Nebraska; Hybrid; USD 250,000 - 380,000; Full time

Job summary

Blue Cross and Blue Shield of Nebraska is seeking a Medicare Medical Director to oversee clinical quality, care management, and population health outcomes for the Medicare Advantage population. You will lead program development, collaborate with physicians, and drive cost-effective care improvements across primary and specialty settings.

The role requires MD/DO with board certification, 7+ years direct clinical experience, 2+ years managed care experience, and willingness to travel to on-site

Qualifications

• MD/DO with board certification in ABMS.
• Seven years of direct clinical (patient care) experience.
• Two years of managed care experience, preferably Medicare Advantage.
• Ability to travel to on-site practices.
• Equivalent education/experience acceptable.
• Strong attendance and timeliness.
• Ability to collaborate in a team environment.

Responsibilities

• Oversee clinical quality, care management, and population health outcomes and costs for the Medicare population.
• Identify opportunities for program enhancements and new initiatives.
• Lead clinical engagement with market leadership to drive quality improvement.
• Improve documentation and risk adjustment to enhance patient care.
• Build relationships with physicians and staff to disseminate best practices and reduce unplanned utilization.
• Collaborate with partners to optimize quality initiatives across Medicare.
• Serve as the liaison to network providers for Medicare services.

Skills

Clinical leadership

Care management

Population health

Travel readiness

Education

MD/DO

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 posses:

• 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.

On the cutting edge of the health care industry, helping Nebraskans in moments of joy, times of hardship and the steps in between. We are Blue Cross and Blue Shield of Nebraska (BCBSNE), and we exist to be there for people when they need us.

Our goal is to add more good, healthy years to people’s lives by supporting our customers and the Nebraska community at large.

We have more than 80 years of experience behind us. And a bright future ahead as we continuously innovate to drive health care forward while meeting the needs of our members and state.

If you’re passionate about helping people along their health journeys, we invite you to explore our career offerings. Here, you will find opportunities to grow personally and professionally while making a difference for our customers and greater Nebraska community.