Medical Director – Population Health, Provider Education

🕒 July 30

🦌 Connecticut, New Jersey, +2 more states – Remote

🦌 Connecticut – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🔔 Pennsylvania – Remote

💵 $214.1k - $297.9k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

👻 Ghost score 72%

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Horizon Connect @ Wall BCBSNJ

WebsiteLinkedInAll Job Openings

2 - 10 employees

⚕️ Healthcare Insurance

🏥 Healthcare

Healthcare Insurance • Healthcare

Horizon Connect @ Wall BCBSNJ is a LinkedIn presence or local program/office associated with Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ). Based on the name and context, it appears to be connected to Horizon BCBSNJ’s health insurance operations and local outreach or member/provider engagement in the Wall, NJ area. Publicly available information provided is limited and mostly LinkedIn site chrome rather than a company profile, so this description is conservative and based on the affiliation indicated by the name.

📋 Description

• Design curriculum for provider education covering value-based clinical workflows, utilization reduction strategies, quality, member experience, health equity and disparities, and risk adjustment/coding. • Develop provider education materials and approaches for providers at varying levels of readiness to transform. • Collaborate with internal and external subject matter experts to incorporate relevant materials, insights, and strategies. • Partner with SIG workstreams to ensure learnings and strategy are incorporated. • Research and incorporate global, national, and state-based evidence-based practices. • Use Voice of Provider and Population Health survey outputs to inform provider education. • Create provider transformation evaluation processes for benchmark and interval evaluation. • Identify and refine key KPIs with enterprise partners for partner-facing initiatives across the value-based and fee-for-service partner portfolio. • Research forward-thinking transformation practice models and programs for partner playbooks. • Partner with network facilities and providers to develop and implement quality, cost-management, and performance initiatives. • Establish multidisciplinary teams for partner transformation engagement. • Serve as physician subject matter expert for enterprise projects related to transformation and Health Care Value. • Design, update, implement, and review biannual value-based partner population health surveys. • Train the value-based team on interpreting clinical insights reports and delivering messages to partners. • Research, design, update, and implement value-based quality programs for each program year. • Lead a team of clinical transformation and quality improvement specialists.

🎯 Requirements

• Requires an Medical Doctor (MD) or Doctor of Osteopathy (DO) degree. • Requires a minimum of 10 years clinical experience in patient centric/value based setting. • NCQA certification preferred. • Requires a minimum of 5 years of medical management experience in a managed care setting. • Requires physician leadership experience in integrated delivery systems with financial accountability. • Requires experience with management of physicians and non-physicians. • Current unrestricted Medical Doctor (MD) or Doctor of Osteopathy (DO) license from the state of New Jersey. • Knowledge of principles of population health and value based care. • Knowledge of Principles of Utilization Management, URAC, NCQA UM Standards, and peer review. • Knowledge of state and federal regulations including DOBI, DMAHS, and CMS. • Knowledge of managed care and health care delivery systems. • Knowledge of managed care operations, policies, and reimbursement. • Knowledge of medical practice management. • Broad clinical knowledge and understanding of current health care issues. • Strong clinical acumen covering physical health issues, behavioral health issues, and social determinants of health. • Medical literature analysis. • Interpretation and application of medical policy. • Excellent verbal, written, and presentation skills. • Expertise delivering highly technical information to a general audience. • Personal computer and applicable software proficiency. • Virtual communication platform proficiency. • Ability to balance clinical issues with business imperatives in the context of social responsibility. • Ability to evaluate data from various sources to identify trends and issues. • Professional and ethical business practices and adherence to company standards. • Ability to manage multiple priorities and deliver timely, accurate work products with a customer service focus. • Sound judgment and strong problem-solving skills. • Ability to manage physicians and employee staff. • Ability to build alliances with the provider community and understand practicing physicians in New Jersey. • Ability to foster internal cross-organizational collaboration. • Employees must live in New Jersey, New York, Pennsylvania, Connecticut, or Delaware.

🏖️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • Paid Volunteer Time Off • Tuition Reimbursement

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