Plays an integral role in the development of a robust clinical product strategy that continuously builds and expands the clinical profile of the BCBS brand and generates sustained value in execution of deliverables.

Clinical Expertise

• Provide strategic insight and tactical direction to support cross functional clinical projects and initiatives that directly impact the BCBSA agenda, NorthStar and strategic pillars.
• Partnering with peer colleagues and cross-functional teams, to provide strategic medical direction to support the needs of the business (i.e. Distinction Program and clinical quality in partnership and collaboration with other internal teams.
• Provide internal and external education and expertise to support innovation and market adoption of best practices and new technologies in a variety of settings, including conferences, webinars, and site visits (as needed)

Clinical Process Optimization

• Responsible for the development of continuous improvement in standards of practices, process, and tool documentation.
• Collaborates cross-functionally on the development, management, maintenance of deliverables [i.e., timelines, study plans, etc.] using rigorous data analysis and strong inter-personal influencing skills to make robust data driven decisions.
• Contribute to the preparation and review of clinical program documents and other study related documents assuring quality and consistency.

Drives Financial Performance

• Manages within budget to forecast and strategic workforce planning.
• Strong understanding of the cost drivers, attuned to principles of clinical cost disciplined management.
• Proactive identification of potential risks and development/implementation of actions to avoid or mitigate and able to make the appropriate trade-offs of balancing risks with study deliverables and costs.

Leadership

• Cultivates an inclusive environment of inter-professional collaboration and teamwork that recognizes and encourages professional and personal development.

Plan related responsibility

• Interacts extensively with Plan Medical Directors, Plan Chief medical officers and clinical researchers and practitioners within BCBSA, the BCBS system, FEP and externally. Specific contacts may include subject matter experts within healthcare, biomedical and biotechnology and government agencies. Interacts with BCBSA and Plan Legal and government relations staff.

Education

• Required - MD; M.D. or D.O., Board certified and unencumbered license
• Masters Degree - M.P.H. or other advanced degree is desired

Certifications

• Medical license and board certification

Experience:

• A minimum of 5 years health plan experience, as Medical Director or higher
• Experience in management of individuals with advanced training including MDs and/or PhDs

Skills

• Expert knowledge of medical cost and quality management especially Medicare Stars
• Knowledge of Plan policy implementation, claims operations and provider and account relations
• Highly skilled at working cross-functionally with key internal and external stakeholders
• Excellent written communication and presentation skills

People Management

• Yes

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