Executive Medical Director Idaho

The Executive Medical Director for Idaho provides internal and external medical leadership of health plan services. As part of the state Executive Leadership Team, partners with Sales and Network Management to provide clinical leadership within the market. As part of the Health Care Services Leadership Team, manages medical cost trend and provides leadership to strategies focused on improving clinical performance both within the state and throughout the health plan.

Responsibilities & Requirements:
In partnership with other physician and clinical leaders, take action to positively impact key clinical performance indicators across the health plan (admits/thousand, readmissions/thousand, ER utilization, cost of care, etc.).

• Understand and interpret clinical data to provide subject matter expertise and consulting on a variety of medical management and policy issues that arise throughout the year.
• May manage VIP cases, second or third level appeals and/or appeal panels. Provide education and consulting to internal staff or external providers as needed.

Identify and implement short and long-range strategies to reduce medical cost trend and achieve medical cost savings targets across the health plan.

• Identify the factors impacting medical cost trend and possible medical management, contracting, or other interventions.
• Stay abreast of industry, medical, and technology trends and chair or participate on workgroups related to development of medical policies and/or strategies.
• Collaborate with others to implement actions to reduce cost trend (e.g. through medical policies, vendor programs, provider communication and coding).

Support market-based Provider Network, Contracting and Provider Partnership Innovation.

• Partner with Provider Partnership Innovation Team to prepare for Joint Operating Committee (JOC) meetings with local providers related to value-based contract arrangements. Analyze data to determine opportunities for improvement and to help achieve success. May present/interpret data to provider during JOC.
• Support Network Management Team as needed by meeting with providers when there are clinical issues related to medical policy, reimbursements, or specific provider negotiations.
• Provide oversight of clinical aspects for provider credentialing and related issues.

Serve on the Executive Leadership Team for the state and provide clinical leadership necessary to promote sales growth and retention.

• Support Sales and Account Management Teams by partnering on sales strategies, RFP responses, and presentations for new accounts. Provide Utilization Cost Reviews (UCRs) for current accounts.
• Monitor and report on cost of care, quality and health outcomes issues within the local market and ensure alignment between state and organizational priorities.
• Provide external clinical face for Cambia regarding a variety of medical issues e.g. legislative or community affairs activities.

Serve as physician leader for assigned departments, work teams, projects or lines of business and achieve results based on specific assignments.

• Develop and communicate strategies, effectively manage resources or programs, achieve operational goals.
• May manage staff including hiring, performance management, development and retention and may participate in talent planning discussions within Health Care Services.

Minimum Requirements:

• Demonstrated competency working with hospitals, provider groups, or integrated delivery systems to reduce healthcare costs and improve outcomes.
  
• Passion for population health and healthcare transformation.
  
• Strong communication, presentation and facilitation skills with all levels of the organization and executive-level external partners, including the ability to resolve issues and build consensus among groups of diverse stakeholders.
  
• Proven ability to develop and maintain positive working relationships with community and provider partners. Sales and/or provider partnership experience preferred.
  
• In-depth health plan expertise including knowledge of industry trends, state and federal regulations, provider reimbursement methods and evolving accountable care and payment models.
  
• General business acumen including understanding of market dynamics, financial/budget management, data analysis and decision making. Strong orientation to the application of data in managing health and quality
  
• Proven ability to develop creative strategies to accomplish goals and objectives, plan and execute complex projects and programs, and drive results across internal teams and/or external partners.
  
• Leadership experience with demonstrated ability to effectively coach and manage others.
  

N

o rmally to be proficient in the competencies listed above:
Executive Medical Director would have a MD or DO degree (also prefer a MBA, MPH, or MHA degree), at least 5 years clinical experience, plus healthcare and/or health plan leadership experience, or equivalent combination of education and experience. Active, unrestricted license to practice medicine in one or more states or territories of the United States. Board Certification is required for Medical Directors conducting certain appeal reviews; otherwise Board Certification is preferred.
Qualification by training and experience to render clinical opinions about medical conditions, procedures, and treatments under review.

About Us:
Regence employees are part of the larger Cambia family of companies, which seeks to drive innovative health solutions. We offer a competitive salary and a generous benefits package. We are an equal opportunity employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A drug screen and background check is required.

Regence is 2.2 million members, here for our families, co-workers and neighbors, helping each other be and stay healthy and provide support in time of need. We’ve been here for members more than 90 years. Regence is a nonprofit health care company offering individual and group medical, dental, vision and life insurance, Medicare and other government programs as well as pharmacy benefit management. We are the largest health insurer in the Northwest/Intermountain Region, serving members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (in Washington). Each plan is an independent licensee of the Blue Cross and Blue Shield Association.

If you’re seeking a career that affects change in the health care system, consider joining our team at Cambia Health Solutions. We advocate for transforming the health care system by making health care more affordable and accessible, increasing consumers’ engagement in their health care decisions, and offering a diverse range of products and services that promote the health and well-being of our members. Cambia’s portfolio of companies spans health care information technology and software development; retail health care; health insurance plans that carry the Blue Cross and Blue Shield brands; pharmacy benefit management; life, disability, dental, vision and other lines of protection; alternative solutions to health care access and free-standing health and wellness solutions.