Medical Director – Population Health, Provider Education

Job not on LinkedIn

🕒 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 41%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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, develop, and deliver provider education and performance management initiatives supporting the Quadruple Aim • Cultivate relationships with internal and external stakeholders and key providers • Deliver customized analytic and evidence-based performance management solutions supporting quality outcomes and value-based care goals • Refine and devise provider and partner engagement strategies • Increase collaboration, improve care management, and encourage care delivery innovation • Lead a team of clinical transformation and quality improvement specialists • Design curriculum for provider education on value-based clinical workflows, utilization reduction, quality, member experience, health equity, disparities, and risk adjustment/coding • Develop provider education materials for providers at varying levels of readiness to transform • Collaborate with internal and external subject matter experts • Partner with SIG workstreams to incorporate learnings and strategy • Research and incorporate global, national, and state evidence-based practices • Use Voice of Provider and Population Health survey outputs to inform initiatives • Create provider transformation evaluation processes for benchmark and interval evaluation • Identify and refine KPIs for partner-facing initiatives driving change in VBP and FFS portfolios • Research transformation practice models and programs for partner playbooks • Partner with network facilities and providers to develop initiatives that drive quality, manage cost, and improve performance • Establish multidisciplinary teams for partner transformation engagement • Serve as physician SME for enterprise transformation and Health Care Value projects • Design, update, implement, and review biannual value-based partner population health surveys • Train value-based teams on interpreting clinical insights reports and delivering messages to partners • Research, design, update, and implement value-based quality programs for each program year

🎯 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, behavioral health, 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 • Proficiency with personal computer, applicable software, and virtual communication platforms • Ability to evaluate data from various sources to identify trends and issues • Professional and ethical business practices • Ability to manage multiple priorities and deliver timely, accurate work products • Strong problem-solving and sound judgment • Ability to manage physicians and employee staff • Ability to build alliances with the provider community and understand practicing physicians in NJ • Ability to foster internal cross-organizational collaborations

🏖️ Benefits

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