Senior Medical Director, Cost Optimization & Affordability

Horizon Blue Cross Blue Shield of New Jersey; Newark (NJ); On-site; USD 240,000 - 334,000; Full time

Benefits offered by this job

Health benefits

Retirement plans

Generous PTO

Incentive plans

Wellness programs

Paid volunteer time off

Tuition reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a Senior Medical Director for Affordability to lead medical cost optimization strategies and cross-functional initiatives. You will collaborate with strategy, analytics, finance, and operations to size projects, influence senior leadership, and drive affordability targets.

The role requires an MD/DO with board certification, 5+ years clinical practice, and 3+ years in managed care, with leadership experience and strong communication skills.

Qualifications

• MD or DO with unrestricted license and board certification.
• Minimum 5 years clinical practice experience.
• Minimum 3 years in managed care/medical management.
• Proficiency with Windows and MS Office.
• 3 years of management experience.

Responsibilities

• Define a multi-year Medical Cost Optimization strategy to drive affordability.
• Collaborate with MCO Strategy Lead and business units to identify opportunities.
• Work with Clinical Analytics, Medical Economics, Finance to size business cases.
• Track and report MCO data for ROI analyses and progress.
• Guide evaluation and prioritization of MCO solutions.
• Participate in MCO Committee meetings and funding prioritization.
• Coordinate with MCAP, Finance and Actuary on performance tracking.
• Communicate MCO strategy and results across Horizon BCBSNJ.
• Educate staff on MCO tools, strategies, programs.
• Manage and develop staff; conduct performance reviews and salary administration.

Skills

Executive leadership

Strategic planning

Healthcare cost optimization

Communication

Data analysis

Education

MD/DO with unrestricted license

ABMS board certification

NJ medical license preferred

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a Senior Medical Director for Affordability to lead medical cost optimization strategies and cross-functional initiatives. You will collaborate with strategy, analytics, finance, and operations to size projects, influence senior leadership, and drive affordability targets.

The role requires an MD/DO with board certification, 5+ years clinical practice, and 3+ years in managed care, with leadership experience and strong communication skills.