Medical Director-Population Health/Provider Education

Horizon Blue Cross Blue Shield of New Jersey•Hopewell, NJ

8d•$214,100 - $297,885

About The Position

The Medical Director is responsible for designing, developing, and delivering provider education and performance management initiatives that support the Quadruple Aim: improving patient and provider experience, population health, and affordability. The role cultivates relationships with internal and external stakeholders and key providers to deliver customized, analytic, evidence-based performance management solutions supporting quality outcomes and value-based care goals. It refines strategies for provider and partner engagement to increase collaboration, improve care management, and encourage care delivery innovation. The Medical Director leads a team of clinical transformation and quality improvement specialists. The position develops provider education and transformation approaches, evaluates performance, identifies key performance indicators, and researches evidence-based and forward-thinking practices. It partners with facilities, providers, and enterprise teams to implement quality, cost-management, and performance initiatives, and serves as a physician subject-matter expert on transformation and health care value projects.

Requirements

MD or DO degree.
At least 10 years of clinical experience in a patient-centric or value-based setting.
At least 5 years of medical management experience in a managed care setting.
Physician leadership experience in integrated delivery systems with financial accountability.
Experience managing physicians and non-physicians.
Current unrestricted New Jersey MD or DO license.
Knowledge of population health and value-based care principles.
Knowledge of utilization management, URAC, NCQA UM Standards, and peer review.
Knowledge of state and federal regulations, including DOBI, DMAHS, and CMS.
Knowledge of managed care and health care delivery system models, managed care operations, policies and reimbursement, and medical practice management.
Broad clinical knowledge and understanding of current health care issues.
Clinical acumen across physical health, behavioral health, and social determinants of health.
Ability to analyze medical literature and interpret and apply medical policy to guide others.
Excellent verbal, written, and presentation skills, including the ability to communicate highly technical information to a general audience.
Ability to use a personal computer, applicable software, and virtual communication platforms.
Ability to balance clinical issues with business imperatives and directives in the context of social responsibility.
Ability to evaluate data from various sources to identify trends and issues.
Professional and ethical business practices, adherence to company standards, and commitment to personal and professional development.
Ability to manage multiple priorities and deliver timely, accurate work products with a customer-service focus.
Sound judgment and strong problem-solving skills.
Ability to manage physicians and employee staff.
Ability to build alliances with the provider community and understand the mindset of practicing physicians in New Jersey.
Ability to foster internal cross-organizational collaboration to support project design and delivery.

Nice To Haves

NCQA certification preferred.

Responsibilities

Design curriculum for provider education, including value-based clinical workflows, utilization reduction strategies, quality, member experience, health equity and disparities, and appropriate risk adjustment and coding.
Develop provider education materials and approaches for providers at varying levels of readiness to transform.
Collaborate with internal and external subject-matter experts to incorporate relevant materials, insights, and strategies.
Partner with SIG and its workstreams to incorporate learnings and strategy.
Research and incorporate global, national, and state-based evidence-based practices.
Use Voice of Provider and Population Health survey results to inform provider education and transformation work.
Create a provider transformation evaluation process for benchmark and interval evaluation.
Identify and refine key performance indicators with enterprise partners for partner-facing initiatives across value-based and fee-for-service partner portfolios.
Research transformation practice models and programs for 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, including transformation coach interactions, clinical collaboration calls, and special KPI projects.
Serve as physician subject-matter expert for enterprise projects related to transformation and health care value.
Design, update, implement, and review biannual value-based partner population health surveys.
Train the value-based team to interpret clinical insights reports and deliver messages to partners.
Research, design, update, and implement the value-based quality program for each program year.
Lead a team of clinical transformation and quality improvement specialists.