Resp & Qualifications
The Medical Director- Sales & Affordability Strategy serves as the strategic business partner responsible for designing, leading, and supporting innovative care management solutions across the organization. Proactively addresses barriers to receiving care in efforts to promote health equity, both physical and mental for members and stakeholders including brokers and key employer accounts. In this role, the Medical Director is responsible for connecting care and cost trend findings to potential gaps in current state solutions and developing an integrated strategy to improve access and affordability for CareFirst members and stakeholders.
-Acts as a subject matter expert to represent CareFirst’s products and clinical solutions during during discussions with employer clients, prospective and current, as well as brokers.
-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 CareFirst departments including but not limited to Health Services, Quality, Care Management, Value based programs, Wellness, Clinical Programs, Pharmacy, Dental, Sales and Marketing. Anticipates member and account needs in response to national and local health care trends. Develops an integrated strategy that addresses those needs and further positions CareFirst as a market leader, in consultation with department leadership.
-Leads CareFirst’s Affordability Program. Translatescost trends for all product types and all lines of business into actionable strategies to improve healthcare affordability. Consults on the implementation of key CareFirst affordability initiatives, mapping initiatives to the integrated strategy for care management solutions and identifying opportunities to scale. Socializes the impact of key healthcare affordability initiatives with CareFirst executive leadership and stakeholders.
-Directs the strategic and the day-to-day activities of the Department, including coaching and guiding individuals and teams to implement departmental, divisional, and organizational mission/goals. Recruits, retains, and develops a high performing team. Evaluates performance of each team member, generates development plans and sets goals within the context of the corporate policies and procedures. Develops annual goals, and prepares, monitors, and analyzes variances of departmental budgets in order to control and appropriately allocate resources.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education Level: Medical Degree
Education Details: Medical Degree from an accredited medical school, completion of an American residency program required with postgraduate training.
-5 years clinical practice experience
-5 years managed care, consulting or related field.
Licenses and Certifications:
-MD Physician State Licensure - Current license to pratice in Maryland without restriction and Board Certification - upon hire.
-Mixed clinical experience in independent and health system-owned environments.
-Related Graduate degree such as MBA, MPH
Knowledge, Skills and Abilities:
Knowledge of managed care concepts and care management activities - Expert
Skilled in coordinating and collaborating with physicians - Advanced
Knowledge of patient rights and laws relative to those rights, such as HIPAA - Advanced
Demonstrated application and knowledge of best health clinical practices - Advanced
Knowledge of principles, practices, evidence-based guidelines and standardized processes and procedures for evaluating medical support operations business practices - Advanced
Demonstrated experience with conducting and facilitating presentations to senior level stakeholders - Advanced
General understanding of health care claims data, trend analysis, and insurance operations and products. - Advanced
Ability to mentor and coach associates to accomplish goals, provide objective evaluation of associate performance, and implement strategies to improve individual and team-based performance as needed.
Department: Sales Support and Affordability
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: 6/20/2021
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
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