Medical Director

<strong>At Emergent Holdings, we&rsquo;re creating an innovative environment where our employees belong authentically, contribute meaningfully, and thrive intentionally &mdash; both personally and professionally.</strong>

Southfield, USA

Emergent Holdings

<h3><strong>Attention:</strong></h3> <p><strong>From Dec. 7, 2020 until Dec. 27, 2020, we will be undergoing a transition to a new recruitment technology platform. During that time, we will not be able to accept applications.</strong></p> <p><strong>We apologize for any inconvenience this may cause.</strong></p> <p><strong>We appreciate your interest in joining our team, and would love for you to come back on Dec. 27 to apply.</strong></p> <p><strong>Thank you!</strong></p> https://emergentholdingsinc.com/

keywords: summary,work environment,care management,medical and payment policy,member experience,utilization,data,leadership,direction exercised,education,experience,skills,knowledge,initiative,deadlines,other abilities

Senior Director

Competitive Compensation and Benefits Package

Overview: <br />Reporting to the VP for Medicare STARs and Clinical Performance, the Medical Director, Clinical Performance is a Senior level role responsible for providing medical leadership over the Senior Health Services team&rsquo;s development and execution of utilization management and care management initiatives. This role will also assist in the development of medical policy and claims payment policy.<br /><br /> <p><strong>WORKING CONDITIONS:</strong></p> <p>Work is performed in an office setting with no unusual hazards. Requires transporting, pushing, pulling, and maneuvering items weighing up to 25 pounds. Travel required.</p>
Responsibilities: <br /> <p><strong>Utilization Management:</strong></p> <ul> <li>In coordination with clinical counterparts elsewhere within the Blue Cross Blue Shield of Michigan enterprise, and with a consistent eye on achieving the &ldquo;triple aim&rdquo;, leads SHS&rsquo;s efforts ideating and implementing initiatives aimed at improving our members&rsquo; total cost of care, overall clinical outcomes, and member experience;</li> <li>Oversees the governance model supporting value capture ideation and implementation;</li> <li>Helps develop appropriate reporting for SHS to provide oversight of clinical trend;</li> <li>Delivers analytic insights related to cost and use, advising leadership and the team of emerging trends and inappropriate utilization (under and/or over)</li> <li>Collaborates with other BCBSM clinical teams to drive maximum value for SHS members.<br /><br /><br /></li> </ul> <p><strong>Care Management:</strong></p> <ul> <li>Receives report from other medical directors who execute physician leadership of holistic and integrated care management teams</li> <li>In support of the VP for Clinical Programs, participates as a thought leader in the process of continuous process improvement related to care management.</li> </ul> <p>&nbsp;</p> <p><strong>Medical and Payment Policy:</strong></p> <ul> <li>Reviews relevant Medicare coverage documentation, scientific literature, and professional society guidelines related to existing and emerging medical technologies and procedures;</li> <li>Actively represents SHS on the Blue Cross Blue Shield of Michigan Joint Uniform Medical Policy Committee;</li> <li>In coordination with other BCBSM clinical leaders, reviews and approves payment policies and clinical claims edits for SHS members.</li> </ul> <p>&nbsp;</p> <p><strong>Overall:</strong></p> <ul> <li><a target="_blank">Leads and actively participates in the identification, evaluation, and selection of clinical program, utilization management, and claims editing vendors;</a></li> <li>Identifies key improvement areas and participates in result-driven program development across the business unit;</li> <li>Reviews quantitative and qualitative data in developing plans to achieve goals;</li> <li>Responsible for balancing workload to optimize the effectiveness of the department;</li> <li>Provides leadership, planning, project coordination, and management for the development of a cost-effective department while concurrently facilitating efficient operations to meet current and future business needs within the organization;</li> <li>Represents Senior Health Services in community and industry programs and conferences;</li> <li>Upon request, functions as the department head in the absence of the executive leader;</li> <li>Performs other work-related duties and responsibilities as directed, assigned, or requested.</li> </ul> <p>&nbsp;</p> <p><strong>DIRECTION EXERCISED:</strong></p> <ul> <li>May directly supervise exempt and non-exempt staff in accordance with company policies and applicable Federal and State Laws.&nbsp;</li> <li>Responsibilities include, but are not limited to, effectively interviewing, hiring, terminating, and training employees; planning, assigning, and directing work; appraising performance; rewarding and counseling employees; addressing complaints and resolving problems, and supporting and encouraging the engagement process.</li> </ul> <p>&nbsp;</p>
Requirements: <br /> <p><strong>EDUCATION:</strong></p> <ul> <li>Medical Doctor Degree (MD) or Doctor of Osteopathic Medicine (DO) required.&nbsp;</li> <li>Advanced degree, such as MBA, MHA, MPH, MMM, or a related field preferred.&nbsp;</li> <li>Board Certified in a specialty approved by the American Board of Medical Specialists or the American Board of Osteopathy.</li> <li>Current unrestricted state of Michigan Doctor of Medicine (M.D.) or doctor of osteopathy (D.O.) license.&nbsp;</li> <li>Continuous learning, as defined by the Company&rsquo;s learning philosophy, is required.&nbsp;</li> <li>Certification or progress toward certification is highly preferred and encouraged.</li> </ul> <p>&nbsp;</p> <p><strong>EXPERIENCE:</strong></p> <ul> <li>Ten (10) years of progressively more responsible experience in a healthcare environment with demonstrated technical experience that provides the necessary knowledge, skills, and abilities.&nbsp;</li> <li>Five (5) years management or supervisory experience in healthcare strongly preferred.&nbsp;</li> <li>Medicare Advantage revenue experience strongly preferred.&nbsp;</li> <li>Health care practice experience providing services to Medicare Advantage and Medicaid patients required.</li> <li>Broad experience of the Medicare segment and an understanding of the overall Medicare stars program.</li> </ul> <p><em>&nbsp;</em></p> <p><strong>SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:</strong></p> <ul> <li>A capacity to implement tactically to consistently deliver results; well-developed skills in diplomacy and collaboration</li> <li>Achievement of results through collaboration with divisions across large, complex organizations, and an ability to organize and manage multiple priorities</li> <li>Strong analytical and operations management skills</li> <li>Strong planning, program development, project management, and staff development skills.</li> <li>Excellent analytical, organizational, and problem-solving skills, and senior-level skills in managing ambiguous situations and issues.</li> <li>Knowledge of activities, practices, and terminology of the insurance industry, and relevant legal and administrative procedures.</li> <li>Ability to negotiate and establish a personal rapport with opposing parties, and to resolve conflicts in a professional manner.&nbsp;</li> <li>Ability to develop and implement effective and efficient recommendations.</li> <li>Demonstrated drive, determination, and persistence to achieve annual revenue targets.</li> <li>Seasoned management skills to motivate and inspire optimum performance.</li> <li>Presentation skills and confidence to present company and product in one-on-one settings or to large gatherings.</li> <li>A commitment to total customer satisfaction.</li> <li>Demonstrates knowledge of documentation opportunities and clinical documentation requirements.&nbsp;</li> <li>Excellent interpersonal and verbal and written communication skills.</li> <li>Solid time management skills, including the ability to manage multiple activities and competing priorities.</li> <li>Identifies new innovations to streamline procedures and implements technologies to improve efficiency to ensure high standards of care.</li> <li>Demonstrates leadership ability and team-building skills to effectively supervise professional and non-professional staff and interact with all levels of management.</li> <li>Ability to work with and empower others on a collaborative basis to ensure success of unit team. Ability to effectively present budgetary and/or cost information and respond to questions as appropriate.</li> <li>Ability to establish workflows, manage multiple projects, and meet necessary deadlines.</li> </ul>