Job Profile ~Can be located in Northern or Southern CA~
As a leading provider of healthcare and insurance, BSC prides itself on being an innovative pioneer in the health services industry. The Healthcare Services organization is integral in the realization of BSC’s mission, by providing leadership and direction for health management and clinical quality improvement strategies, providing greater value to its members through pharmacy and medical management, and optimally functioning management systems.
The Regional Medical Director (RMD) is accountable for the utilization and quality performance of assigned geographic regions for all product lines (HMO, ACO, PPO, and Medicare). The RMD will report to the Delivery System Medical Directory.
Candidate Profile and Requirements The ideal Regional Medical Director candidate will be an experienced medical management professional who is an innovative thinker, results oriented, and has a strong desire to drive change within the healthcare delivery system. Specific competencies include: Implement Region –Specific Strategy · To achieve the objectives of the position, the RMD is expected to effectively leverage his/her analytic, communication, and organizational skills to drive cost and quality strategies within the network including:
- Development of regional and sub-regional strategies, and a plan to achieve designated utilization and quality goals/targets.
- Using data and evidence based strategies to enhance provider performance in utilization and clinical quality.
· The RMD is responsible for monitoring the region-specific plan to ensure that the plan is executed as intended, making periodic adjustments to the plan as necessary, in order to achieve desired affordability, clinical quality and member experience targets.
Work with Internal BSC Partners · Provide clinical input to assist in the evolution of medical management strategy and best practice development. This includes the integration of traditional UM strategies, ACO and other delivery system model interventions which might influence practice patterns using an integrated approach.
· Partner with network management to develop new methods to incentivize providers using Value Based Pay for Performance and other incentive plans to ensure consistency of messaging and optimization of behavior change in the delivery system.
· Partner with BSC Health Care Services (HCS) teammates, including utilization management, concurrent review, case management, ACO team, BSC Pharmacy and clinical quality improvement, among others.
· When needed, help resolve issues from BSC providers regarding case and disease management
Engage Key Delivery System Partners · The RMD proactively engages with key delivery system partners to influence care delivery and remove barriers to efficient, high quality care for BSC members. These collaborations include:
- Hospital leadership such as a Vice President for Medical Affairs, Chief of Medical Staff, hospitalist group leader, Emergency Department director, or service line chairs to address thematic areas of opportunities that could reduce admissions and/or improve timeliness and success of discharges. In addition, work with the ACO team to influence changes in hospital care delivery through the partnership model.
- IPA/Medical Group leadership including the Medical and UM Directors to address hospital bed day and ED utilization opportunities including working with the ACO team to influence changes in care delivery and though the ACO collaboration model.
- Individual high volume providers who manage BSC members by providing feedback on issues such as discretionary use of services, quality metrics and performance, and hospital utilization.
Subject Matter Expert · The RMD serves as a resource and subject matter expert for numerous BSC functions such as:
- Implementing regional and sub-regional strategies
- Development of new models for care delivery
- Serving as the effecter for various BSC initiatives such as PCMH, and e-prescribing
- Medical policy development
- Cost of Healthcare projects
- Benefit policy and development
- Delegation oversight
Job Required Education/Experience Attributes/Characteristics The successful candidate will have industry experience, strong leadership skills and will be a strong communicator. A genuine and results-oriented innovator will excel in this role. Additionally, the Regional Medical Director should possess: Key Leadership Competencies · Business Acumen
· Drive for Results
· Leadership Influence
· Interpersonal Excellence
· Change Management
· Balanced Perseverance
· Customer Focus
· Financial/Quantitative Acumen
· Active, unencumbered CA license (MD or DO)
· 5-10 years managed care experience
· Prior health plan experience preferred - specifically as a regional medical director
· IPA/Medical Group experience with >100,000 enrollees
· Prior clinical work and board certification in Internal Medicine, Family Practice, Pediatrics, or Emergency Medicine preferred
Job Additional Education/Experience O ur C ultu r e · Bl u e S hi e l d i s ded ica t ed to a h e al t h y an d happ y w o r k f o r c e . O u r ai m i s t o hi re p e o pl e w h o w i l l t h r i v e in ou r e n v i r o n me n t an d ca re ab ou t w ha t w e ca re a b ou t . Wh en eve r yo n e i s 100% r e s p o n s ibl e f o r s u s t ainin g ou r c u l t u re i t e n s u res t ha t w e m ai n t ai n a gre a t w o r k plac e. B e ca u s e w e a re a h e al t h ca re c o m pan y i t i s e s se n t ia l t h a t em pl oy ees h o l d p er so na l w e lln e s s a p r i o r i t y n o m a tt er w h ere h e /s h e i s w i t h t h e i r h e a l t h s t a t u s. O u r in t er na l w e l l n e s s p r o g r a m , W e ll v o l u t i o n i s a n a w a r d - w i n nin g we lln e s s p r o gr a m p r o ven t o b o os t em pl oy ee h e al t h , e nhanc e p r o d u c t i v i t y an d red uc e med ica l clai ms c os t s . W e w o rk ha rd t o m ak e i t e a s y t o li ve w e l l a t B l u e S hi e l d.
· O u r c u l t u re i s a m i s s i o n- dr i ven c u l t u re. W e c o u n t o n every e m pl o y ee t o a s s i st m akin g ou r m i s s i o n a r e ali t y . Whil e w e a re p u r su in g o u r m i s s i o n an d s t r a t eg y , w e ex p e c t t h a t a l l em pl oy ees a re s t e w a rds o f o u r c o m pan y v alu e s .
BSC offers a competitive compensation package comprised of base salary, short and long term bonuses, pension eligibility, PTO and full array of insured benefits.