Associate Medical Director

Blue Cross and Blue Shield of North Carolina•Remote Flex - North Carolina, SC

8d•$191,153 - $305,845•Hybrid

About The Position

The Medical Director brings a unique set of knowledge and skills to the business of Blue Cross North Carolina and frequently serves as an interface between the company and physicians, providers, employer and community groups, and members as needed. Utilizes clinical knowledge and experience to support value-based strategies, clinical operations and our organizational pursuit of high quality and cost-effective care for members. The application of a Medical Director’s knowledge and clinical skills will vary across the Health Care division, dependent on focus areas identified by the business area supported.

Requirements

MD or DO from an accredited medical school and completion of residency training program.
5+ years of experience in related field
Current North Carolina medical license required or ability to obtain after hire
Board certification in ABMS/AOA recognized clinical specialty is required

Nice To Haves

Project planning and management
Leadership Skills

Responsibilities

Develops, collaborates and/or drives strategy and approach for varied Health Care and/or organizational initiatives (i.e. sales management strategies, behavioral health strategies, new health care delivery strategies)
Medical reimbursement and policy
Care management (utilization management, case management, PA, appeals)
Healthcare programs (disease management, Moonshots)
Network support (Credentialing)
Quality model design and analysis
Develop strategic partnerships with internal business partners and external clients to support value-based agreements and drive better consumer and provider experience.
Takes a lead role in outreach and relationship building across the community (i.e. providers, health systems, community partners, members, etc).
Evaluate and manage new and/or existing vendors and solution partners to align to BCNC’s strategic direction
Ongoing provider engagement functions
Evaluate clinical and other data to identify opportunities for improvement in health outcomes and financial performance
Discuss data and performance with providers, employers, accreditors and regulators as needed.
Represent BCNC through delivery of presentations, speaking engagements and leadership of advisory groups with external audiences related to health care transformation and BCNC’s initiatives.
Publish high impact content focused on improving accessibility, quality and affordability.
Payment model design
Identify market trends that should influence key investments (new technologies, best practices).
Evaluation of investment/partnership opportunities