Medicare Medical Director — Quality & Population Health

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) 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.