[Remote] Med Dir., Prov Perf & Clin Transf

Note: The job is a remote job and is open to candidates in USA. Horizon Blue Cross Blue Shield of New Jersey empowers members to achieve their best health and is seeking a Medical Director for Provider Performance and Clinical Transformation. This role involves designing and delivering provider education initiatives to enhance patient and provider experiences, improve population health, and promote value-based care.

Responsibilities

• Design curriculum for provider education including but not limited to value based clinical workflows, utilization reduction strategies, quality, member experience, health equity and disparities, and appropriate risk adjustment/ coding
• Develop provider education materials and approaches for providers at varying levels of readiness to transform:
• Collaborate with internal and external SMEs (e.g. other medical Directors, quality and risk adjustment teams, and others) to receive relevant materials, insights, and strategies to be incorporated
• Partner with SIG and their many work-streams to ensure learnings and strategy are incorporated
• Research and incorporate global, national, and state based leading evidence based practices
• Use output of Voice of Provider surveys and Population health surveys to inform this work
• Create provider transformation evaluation process for benchmark and interval evaluation
• Identify and refine key KPIs, in collaboration with enterprise partners, to incorporate into partner facing initiatives that will drive change in our VBP and FFS partner portfolio
• Research forward-thinking transformation practice models and programs for incorporation into partner playbooks to improve performance
• Partner with network facilities and providers to develop and implement initiatives that drive quality, manage cost and improve performance
• Establish multidisciplinary teams for partner transformation engagement, for example, with transformation coach interactions, clinical collaboration calls, special KPI projects, etc
• Serve as physician SME for projects related to transformation and Health Care Value across the enterprise, such as Clinical Performance Measurement & Predictive Analytics, Strategic Initiatives Group, Medical Economics and Risk Adjustment, etc
• Design, update, implement, and review biannual value-based partner population health surveys
• Train value-based team on the interpretation of clinical insights reports and the message delivery to partners
• Research, design, update, and implement value based quality program for each program year

Skills

• Requires an Medical Doctor (MD) or Doctor of Osteopathy (DO) degree
• Requires a minimum of 10 years clinical experience in patient centric/value based setting, NCQA certification preferred
• Requires a minimum of 5 years of medical management experience in a managed care setting
• Requires physician leadership experience in integrated delivery systems with financial accountability
• Requires experience with management of physicians and non-physicians
• Current unrestricted Medical Doctor (MD) or Doctor of Osteopathy (DO) license from the state of New Jersey
• Principles of population health and value based care
• Principles of Utilization Management, URAC, NCQA UM Standards, and peer review
• State and federal regulations i.e. DOBI, DMAHS, CMS
• Principles and concepts of managed care and various models of health care delivery systems
• Principles and concepts of managed care operations, policies, and reimbursement
• Business of medical practice management
• Broad clinical knowledge and understanding of current health care issues
• Strong clinical acumen to support understanding broad physical health issues, behavioral health issues, and social determinants of health
• Medical literature analysis
• Interpretation and application of medical policy to provide guidance to others
• Excellent verbal, written, and presentation skills
• Expertise in the delivery of highly technical information to a general audience
• Personal computer, applicable software
• Virtual communication platforms
• Balance clinical issues with business imperatives and directives in the context of social responsibility
• Evaluate data from various sources to identify trends and issues
• Demonstrate professional and ethical business practices, adherence to company standards, and a commitment to personal and professional development
• Manage multiple priorities, deliver timely and accurate work products with a customer service focus
• Ability to exercise sound judgment with strong problem solving skills
• Manage physicians and employee staff
• Build alliances with provider community and have insight into the mindset of practicing physicians in NJ
• Foster internal cross organizational collaborations to support project design and delivery

Benefits

• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement

Company Overview