Senior Medical Director, Medical Cost Optimization

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

Benefits offered by this job

Comprehensive health benefits

Retirement plans

Generous PTO

Job summary

Horizon Blue Cross Blue Shield of New Jersey seeks a Senior Medical Director for Affordability to lead medical cost optimization initiatives. This physician leader drives multi-year strategies, partnering with MCO strategy and execution teams to improve affordability, quality and clinical outcomes.

The role requires an MD/DO with an unrestricted license, ABMS board certification, and 5+ years clinical practice plus 3+ years in managed care.

Qualifications

• Requires MD or DO with an unrestricted license to practice medicine.
• Board certification by ABMS.
• Minimum 5 years of clinical practice experience.
• Minimum 3 years of managed care/medical management experience.
• Proficiency with MS Office and Windows.
• Minimum 3 years of management experience.
• Knowledge of clinical operations within a managed care organization.
• Experience with utilization management, quality, payment integrity, case management, or medical policy.
• Knowledge of medical cost optimization.
• Strong communication and executive presence.

Responsibilities

• Define a multi-year Medical Cost Optimization (MCO) strategy and implement it.
• Partner with leadership to identify MCO opportunities and drive process improvements.
• Collaborate with Clinical Analytics, Medical Economics, Finance to size and validate MCO business cases.
• Oversee tracking, analysis and reporting of MCO data for ROI analyses.
• Direct MCO work to prioritize opportunities using CPLT/DRIVE governance processes.
• Lead MCO Committee meetings and communicate strategy across Horizon BCBSNJ.

Skills

MD/DO license

ABMS board-certified

Clinical practice 5+ years

Managed care 3+ years

MS Office proficiency

Management experience 3+ years

Clinical operations in MCO

Utilization management

Medical cost optimization

Executive communication

Executive presence

Education

MD or DO

Unrestricted medical license (NJ preferred)

Job description

Horizon Blue Cross Blue Shield of New Jersey seeks a Senior Medical Director for Affordability to lead medical cost optimization initiatives. This physician leader drives multi-year strategies, partnering with MCO strategy and execution teams to improve affordability, quality and clinical outcomes.

The role requires an MD/DO with an unrestricted license, ABMS board certification, and 5+ years clinical practice plus 3+ years in managed care.