Resp & Qualifications
CareFirst is a not-for-profit corporation which is the largest health insurer in the mid-Atlantic region with more than 3 million Members, 5,000 associates and more than $8 billion in annual revenue. The company is regarded as a top employer in many surveys and offers competitive salary and benefits.
The Sales & Affordability team is a new department within Clinical Programs and Evaluation that will support the company in delivering high value products and programs to our employer groups and members. The Medical Director represents all aspects of CareFirst’s products and care management programs to brokers and key employer accounts and is responsible for monitoring and evaluating cost of care trends and implementing cost savings strategies.
The Medical Director represents CareFirst’s products and care management programs during new business presentations, upon renewal, and during annual account updates. Responsible for representing CareFirst to brokers and accounts with regard to national, local and account specific healthcare trends, as well as all aspects of care management including Care Management, Disease Management, Wellness, Transition of Care, Patient-Centered Medical Home (PCMH), Ancillary, Pharmacy Management, and other clinical programs.
The Medical Director is accountable for evaluation and monitoring of the cost of care trends, translating evaluation findings into actionable improvements, and developing solutions that will have a positive impact on the global cost of care for our members and employer groups. The Medical Director collaborates cross functionally across the enterprise with internal stakeholders and manages a team that implements cost saving strategies that may span product development, provider payment policies, clinical programs, care management or other operational units.
Under the general direction of the Vice President, Clinical Programs and Evaluation, the incumbent’s responsibilities include, but are not limited to, providing leadership, and oversight as follows:
1. Represent Medical Affairs to Support Sales Teams
• Represents CareFirst’s products and care management programs during new business presentations, upon renewal, and during annual account updates.
• Acts as subject matter expert on all aspects of care management including Care Management, Disease Management, Wellness, Transition of Care, Patient-Centered Medical Home (PCMH), Ancillary, Pharmacy Management, and other clinical programs.
• Conducts sales presentations and interfaces with a variety of brokers and accounts.
• Interprets and implements policies and procedures to monitor overall efficiency and adherence standards for CareFirst.
• Develops and implements programs for education of affiliated clients.
• Liaison to other departments and divisions for interpretation of Medical Affairs policies and practices.
• Serves as clinical and administrative resource and ensures adherence to policies, procedures and external regulatory agencies.
• Works with Medical Policy, Quality, Care Management, PCMH, Wellness, Pharmacy and Dental management areas to anticipate account needs and provide innovative solutions in response to national and local care management trends.
2. Trend and Account Reporting
• Provides expertise to accounts with regard to national, local and account-specific healthcare trends.
• Partner with Actuary in trend analysis work group that is charged with evaluating and monitoring utilization and cost trends for all product types and all lines of business.
• Develop actionable insights and recommendations based on trend evaluations.
• Work with Actuary, Sales, Marketing, Underwriting and Informatics staff to design and deliver high quality reports and presentations for use with external accounts in both the Risk and Non-risk segments.
• Collaborates with internal stakeholders to identify and prioritize high impact opportunities for savings that may span product development, provider payment policies, clinical programs, care management or other operational units.
• Responsible for cross-functional work teams to implement cost savings strategies.
• Consults with Medical Affairs area in the design and implementation of Care Management strategies that support the dynamic health care marketplace and meets the needs of accounts.
• Medical Degree from an accredited medical school, completion of an American residency program required with postgraduate training.
• Board Certification
• Current license to practice without restriction. Current license to practice without restriction in state of Maryland is preferred. If candidate does not have current license in Maryland, the candidate must obtain Maryland license within one year from date of hire.
• Minimum of 3 years of experience in managed care, consulting, or related field.
• Demonstrated experience with conducting and facilitating presentations to senior level stakeholders.
• General understanding of health care claims data, trend analysis, and insurance operations and products.
• An in-depth knowledge of all aspects of current and emerging group-based trends in care management.
• Knowledge of accreditation standards and federal/state regulations relating to quality improvement.
• Proven track record of collaborative, analytic problem solving. An ability to present and discuss analytical information in a way that is persuasive and advances understanding.
• An ability to provide insights and actionable improvements for product and program design, based on analytic findings.
• Thrives in a highly matrixed, cross-functional environment. Strong interpersonal skills, with the ability to effectively influence and collaborate with employees and management at all levels.
• Critical thinking and judgment
• Ability to lead/coordinate projects and act as a resource to other CareFirst departments;
• Effective written and interpersonal communication skills, including executive level presentation skills.
• 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.
• Current license to practice in Maryland without restriction. If candidate does not have current license in Maryland, the candidate must obtain Maryland license within one year from date of hire.
• Related Graduate degree such as MBA, MPH
• 5 years of experience in managed care, consulting, or related field.
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: 6/14/2020
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 up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship