Medical Director, Medicare Strategy

Job Description

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is seeking a Medical Director, Medicare Strategy to join our Health Care division. In this dynamic role, you will serve as the expert Medical Director and Medicare clinical consultant to effectively represent Blue Cross NC externally with health systems, provider groups, and community organizations. You will build and develop partnerships to further healthcare strategies and leverage provider services and capabilities. The Medical Director, Medicare Strategy will utilize clinical knowledge and experience to support value-based strategies, clinical operations and our organizational pursuit of high quality and cost-effective care for members. What You Will Do: • Develop, collaborate and/or drive strategy and approach for varied Health Care and/or organizational initiatives (i.e. segment specific strategies, behavioral health strategies, health care delivery strategies) • Develop strategic partnerships with internal and external partners to implement segment specific strategies and clinical programs aimed at enhancing outcomes, improving cost effectiveness, and driving better consumer and provider experience. • Take a lead role in outreach and relationship building across the community (i.e. providers, health systems, community partners, members, etc). • Represent Blue Cross NC through delivery of presentations, speaking engagements and leadership of advisory groups with external audiences related to health care transformation and Blue Cross NC’s initiatives. • 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. • Obtain competitive intelligence and feedback directly from external stakeholders to enhance our understanding of specific needs for health care and medical expense interventions. • Serve in a consultative capacity with the Blue Cross NC enterprise to provide market insight, develop strategy and serve to recruit potential partners for new and innovative product and program offerings. What You Bring (Hiring Requirements): • MD or DO from an accredited medical school and completion of residency training program. • 7+ years of clinical experience • Significant experience in health care consulting, community/government agency partnership, and/or health plan management is required. • Medicare specific expertise is required – i.e. Medicare Value-Based Arrangements (ACO/CIO) and Medicare Quality Initiatives (Stars and Risk Adjustment). • Excellent presentation, communication and relationship building skills needed. • Current North Carolina medical license and Board certification in ABMS/AOA recognized clinical specialty is required • Travel expectations: up to 25%, mostly in-state travel. • MBA, MHA or MPH preferred. What You’ll Get: • Blue Cross NC is truly a great place to work – and we have the hardware to prove it. Each year, we’re recognized for our commitment to our culture, community, work-life flexibility, benefits and more. Join us and help us make health care better for all! Salary Range At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. • Based on annual corporate goal achievement and individual performance. $185,000.00 - $367,200.00 Apply Job!