CareFirst Careers

Senior Director, Clinical Programs Evaluation & Oversight (Total Care Cost Improvement)

Resp & Qualifications

PURPOSE:
The Senior Director, TCCI Clinical Programs Evaluation and Oversight will manage business strategy and day-to-day operations for a range of clinical programs.  These programs—key components of CareFirst’s innovative Total Care and Cost Improvement (TCCI) and Patient Centered Medical Home Programs—are designed to optimize care for Members with specific clinical conditions and to address the needs of those high-risk members who suffer from conditions that are costly to manage and are often characterized by uncertainty or challenges in diagnosis and treatment.

The Senior Director will work closely with CareFirst’s clinical and care management teams on the design and implementation of these programs.  The Senior Director will work closely with vendor and provider partners to ensure that the programs are followed to contract requirements and to develop and maintain business relationships in the provider communities to ensure optimal performance or the programs.  The Senior Director will work closely with CareFirst’s Strategic Business Units to communicate the value of these programs to our Members.  The Senior Director will manage a team of program managers that support the implementation of these programs.

This is a new position for CareFirst in recognition of the opportunities to improve Members care through innovative programs.  The position will provide critical leadership to the development and implementation of CareFirst’s primary strategy to improve the quality of care and reduce the total cost of care.  The Senior Director will work closely with CareFirst’s senior leadership and the health care community in the Mid-Atlantic region.

The Senior Director will lead the following current programs and be tasked to identify new program opportunities.  Complete descriptions of these programs can be found at: https://provider.carefirst.com/providers/care-management/pcmh-program-description-guidelines.page.

  • Expert Consult Program
  • Urgent & Convenience Care Access Program
  • Community Based Program – Chronic Kidney Disease
  • Community Based Program – Diabetes Education
  • Community Based Program – Congestive Heart Failure
  • Telemedicine Program
  • Dental-Medical Health Program

PRINCIPAL ACCOUNTABILITIES:
1. Strategic and Operational Management of Clinical Programs.

Oversees and manages all day-to-day operations of CareFirst’s clinical programs.  Ensures that programs are operating at full capacity and meet the strategic goals of the company.  Identifies ways to improve program performance and oversees the collection and integration of clinical and other program data into existing CareFirst IT infrastructure to ensure compliance and maximum impact of the program.  Develops a thorough understanding of which CareFirst Members would benefit the most from the programs and develop effective strategies to engage CareFirst Members in them. Partners with existing evaluation and data analysis teams to measure the value of all programs, including via cost savings and clinical outcomes.

Works closely with PCMH and Complex Case Management teams to design and execute programs to have greatest programmatic impact.

Provides frequent updates to CareFirst’s Executive Leadership on the performance of these programs.

2. Recruit, develop relationships and oversee vendor and provider relationships. 

Develops and grows strategic relationships with a range of vendor and provider partners who carry out TCCI programs under his/her purview.  Engages in constant communication with our vendor partners to communicate the value of our programs and how to improve the quality of care. Continually assesses the performance of vendor and provider partners to adhere to our guidelines and contract requirements and to assess their quality of care for CareFirst Members.  Develops formal and informal mechanisms to provide performance feedback to vendor and provider partners.

3. Staff Management

Recruits, retains and develops a small but high performing team of supporting program managers. 

  • Makes decisions regarding the hiring, promotion, development and termination of team members.
  • Reviews staffing goals and expectations to ensure that each is consistent and adequate to meet department goals. 
  • Evaluates the performance of each team member, generates development plans and sets goals within the context of corporate policy. 
  • Provides coaching, counseling and motivation to team members ensuring staff has the appropriate tools and training. 
  • Identifies resource needs.


SUPERVISORY RESPONSIBILITY: 1-3 direct reports; oversight of complex, multi-faceted vendor and provider relationships 

QUALIFICATION REQUIREMENTS:

Required Education/Experience/Skills/Abilities: This position requires a Bachelors degree in business or health care related field.  Minimum of 7 years of experience in the healthcare industry, with strong track record of successful management of innovative clinical programs, in a provider or payer setting. M.D or M.B.A. preferred. At least 5 years of progressively increasing management responsibility leading high performance teams.  Must have deep business acumen and extensive industry expertise including current issues and opportunities for clinical programs in managed care.  In addition:

  • Strong understanding of clinical, operational and regulatory practices for patient-facing clinical programs.
  • Demonstrated success in clinical quality improvement.
  • Strong understanding of digital health and its potential to improve care.
  • Leadership experience in a health care business and/or or clinal setting.
  • Proven capabilities in implementing complex business strategies.
  • Strong relationships with the health care community and a demonstrated ability to build and nurture a network of community-based partners.
  • Demonstrated ability to develop innovative solutions through the application of advanced problem-solving skills and skilled in garnering cross-functional support as required.
  • Superior negotiation skills and analytical skills.
  • Exceptional project and resource management skills.
  • Superior communication skills including excellent written and presentation skills appropriate for senior level executive, stakeholder and account communications.
  • Demonstrated leadership experience including successful matrix management and experience directing successfully integrated IT strategies.
  • Ability to identify solutions to complex business issues, to make difficult decisions, to achieve results through others, and to motivate team effort and cooperation. 
  • Ability to inspire, motivate and guide others toward goal accomplishments.
  • Ability to encourage and facilitate cooperation within the organization and with customer groups; and foster commitment, team spirit, pride, and trust. 
  • Ability to develop leadership in others through coaching, mentoring, rewarding and guiding associates.
  • Must be willing and able to maintain a heavy presence in the field interacting and interfacing with potential and current community based vendor partners.
  • Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time.  Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.   Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Department

Department: Total Care Cost Improvement Clinical Programs

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Closing Date

Please apply before: 5/24/2018

Federal Disc/Physical Demand


Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:
The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights of up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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