Medical Director - Clinical Partnerships

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Detroit, MI

Blue Cross Blue Shield of Michigan

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Competitive Total Compensation Package

Overview: Responsible for providing leadership and broad strategic direction for one or more defined medical areas or functions. Responsible for corporate policy interpretation, recommendation, and review within the recognized area of responsibility.<br /> <p><strong>Departmental Summary:&nbsp;</strong></p> <p>The Medical Director of Clinical Partnerships will be responsible for working with provider organizations and contracted entities to enable and support them to improve the quality of care, decrease unnecessary utilization, and limit unnecessary healthcare costs.&nbsp; This physician will provide clinical input and support within Healthcare Value and Senior Health Services on new programs, vendor led programs, contracts terms, and help drive provider engagement and health plan success in programs including but not exclusive of Stars, HEDIS, Pharmacy, and CAHPS.&nbsp;</p>
Responsibilities: <ul> <li>Provide high level oversight, leadership and direction for one or more defined medical areas or functions.</li> <li>Interpret, recommend and review corporate policy within recognized area of responsibility.</li> <li>Refine conceptual framework and provide broad strategic direction.</li> <li>Develop and approve strategic and operational plans for assigned units or area of responsibility.</li> <li>Impact the performance of BCBSM including short term as well as long term effects on major business units.</li> <li>Other duties as assigned.</li> </ul> <br /> <p><strong>Departmental Preferences:&nbsp;</strong>&nbsp;</p> <p><strong>Essential Duties and Responsibilities:&nbsp;</strong></p> <ol> <li>Work with individual provider contracted entities to evaluate their performance within the contract and opportunities for improvement in quality, utilization, and cost.</li> <li>Ability to evaluate performance dashboards to develop actionable insights into opportunities for improvement.</li> <li>Confident leader who can express clinical concerns with new proposed programs or vendor contracts in order to develop programs that are aligned with business goals and clinical goals for member care.&nbsp;</li> <li>Collaborate with Healthcare Value, Health Plan Business and Senior Health Services teams to operationalize provider enablement efforts to optimize performance in contracts. &nbsp;&nbsp;</li> </ol>
Requirements: <ul> <li>Doctorate from an accredited school of medicine (M.D.) or osteopathy (D.O.) required.</li> <li>Ten (10) year's recent clinical experience in area of specialization plus utilization review experience.</li> <li>Current unrestricted state of Michigan doctor of medicine (M.D.) or doctor of osteopathy (D.O.) license.</li> <li>Board certified or board eligible and working towards certification in a specialty approved by the American</li> <li>Board of Medical Specialists or the American Board of Osteopathy.</li> <li>Certification in Utilization Review preferred.</li> <li>Knowledge of BCBSM, providers, services and facilities.</li> <li>Strong teaching and communication skills.</li> <li>Other related skills and/or abilities may be required to perform this job.</li> </ul> <br /> <p><strong>Education and/or Experience:&nbsp;</strong></p> <ul> <li>Doctorate from an accredited school of medicine (M.D.) or osteopathy (D.O.) required.</li> <li>Ten (10) year&rsquo;s recent clinical experience in area of specialization required.</li> <li>Master&rsquo;s degree in business administration (MBA), health services administration (MHSA), health administration (MHA), medical management (MMM), or public health (MPH) preferred.</li> </ul> <p>&nbsp;</p> <p><strong>Certificates, Licenses, and Registrations:&nbsp;</strong></p> <ul> <li>Current unrestricted state of Michigan Doctor of Medicine (M.D.) or Doctor of Osteopathy (D.O.) license.</li> <li>Board certified or board eligible and working towards certification in a specialty approved by the American Board of Medical Specialists or the American Board of Osteopathy.</li> </ul> <p>&nbsp;</p> <p><strong>Qualifications:&nbsp;</strong></p> <p>To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.&nbsp; The requirements listed below are representative of the knowledge, skill, and/or ability required.&nbsp; Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.&nbsp;</p> <p><strong>Other Skills and Abilities:&nbsp;</strong></p> <ul> <li>Experience in evaluating quality metric performance and identifying areas of improvement in quality metrics.&nbsp;</li> <li>Experience in evaluating utilization performance and identifying areas of improvement in unnecessary utilization.</li> <li>Knowledge regarding the assessment of patient experience and how to improve the patient experience with members, staff, and providers.</li> <li>Experience in operationalizing and successful implementation of either a Medicare Advantage Contract or a Medicare Fee For Service (Medicare Shared Savings Plan, Next Gen ACO, or Direct Contracting model) contract.&nbsp;</li> <li>Familiarity with BCBSM Value Based Reimbursement programs and structure.</li> <li>Experience in evaluating physician performance in quality, cost, and efficiency.</li> <li>History of collaborating with physicians, practices, or physician organizations in operationalizing value-based reimbursement programs.&nbsp;</li> <li>Experience in improvement efforts for risk coding accuracy.</li> <li>Familiarity with Provider Organization structure.&nbsp;</li> </ul>