Medicare Medical Director

About the role

The Medicare Medical Director at Blue Cross and Blue Shield of Nebraska is responsible for overseeing clinical, quality, care management, population health outcomes, and cost for the Medicare population. This role requires a Doctor of Medicine (M.D or D.O) with board certification in an American Board of Medical Specialties Board and a current, unrestricted license to practice medicine in the United States. Seven (7) years of direct clinical experience, including postgraduate direct patient care experience, and two (2) years of managed care experience, preferably with a Medicare Advantage population, are required. The ideal candidate should also have the ability to travel to on-site practices, work well in a team environment, and build positive relationships with other staff, departments, and customers.

Responsibilities

• Oversight of clinical, quality, care management, and population health outcomes and cost for the Medicare population.
• Affirm 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.

Requirements

• Doctor of Medicine (M.D or D.O)
• Board Certified in an American Board of Medical Specialties Board
• A current, unrestricted license to practice medicine in a state or territory of the United States
• 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
• 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

Qualifications

• 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

Skills

• Experience with utilization review/quality assurance
• Direct case management experience
• Demonstrated skills in creating buy-in with internal and external clinician stakeholders to transform clinical care
• Preferred residency in an adult primary care specialty (family medicine, general internal medicine, geriatric medicine, combined internal medicine/peds)

Benefits

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.

Pay

N/A

Schedule

N/A