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