Resp & Qualifications
The Medical Director Special Programs 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 Special Programs 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 discussions with internal and external stakeholders.
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 across different functions with subject matter experts (internally and externally) to support the development of population health and clinical programs that improve healthcare quality, affordability and access for our members and the communities we serve.
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
Directs the strategic and the day-to-day activities of the department or projects/programs (may include coaching and guiding individuals and teams directly or in a matrixed environment), to implement departmental, divisional, and organizational mission/goals.
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.
Experience: 5 years clinical practice experience
5 years managed care, consulting or related field.
In Lieu of Education
Mixed clinical experience in independent and health system-owned environments.
Related Graduate degree such as MBA, MPH
Knowledge, Skills and Abilities (KSAs) Proficiency
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
Additional Skills and Abilities
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. 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.
Licenses and Certifications
MD - Physician - State Licensure Current license to practice in Maryland without restriction. Upon Hire X and
Board Certification Upon Hire X
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: 7.7.21
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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