Cambia Health Solutions

  • Executive Medical Director

    Job Locations US-OR-Portland
    Requisition ID
    2018-24916
    Category (Portal Searching)
    Health Care Services
  • Overview

     

    Executive Medical Director role is an Oregon-based position

     

    As the Executive Clinical Leader in the Oregon market, you will focus on delivering best in class clinical leadership and support by partnering with Sales, Network Management and clinical teams to provide clinical leadership within the Oregon market.

    Responsibilities & Requirements

    Strong clinical consultant capabilities to work with cross functional teams to support the market and customers

    • Detailed understanding of current Care Management programs and ability to work with clinical teams for custom solutions or programs
    • Strong data analytic capabilities to support the identification of cost drivers and solution development based on client needs/conditions
    • Experienced presenter comfortable in customer and prospect settings to represent the full continuum of solutions with ability to speak at level of all stakeholders
    • Detailed understanding of market landscape and continuously seeking knowledge on competitors and third party solutions
    • Strong understanding of network and linkages of clinical programs with value based care to support the development of book of business and customer specific solutions.

     

    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.
    • Lead and/or participate on cross functional task force focused on identification of solutions to impact cost and utilization, quality and/or patient experience.

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

    • Identify the factors impacting medical cost trend, utilization, quality and develop solutions and 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 solutions to reduce cost trend or utilization.

    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.
    • Lead or support network initiatives as needed in the market to further value based care position in the market.
    • Clinical lead in the market with providers and driving the discussion to support overall quality improvements with providers and market level quality initiatives (e.g., BREE).
    • Provide oversight of clinical aspects for network management team.
    • Build relationships with CMOs and CEOs of Washington delivery systems

    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.  
    • Expand market presence through external speaking arrangements and participation in local community initiatives on cost, quality and patient experience.
    • 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

    • 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:

     

    The Executive Medical Director would have a MD or DO degree (with MBA, MPH, or MHA degree desired), and 3 or more years of  health plan experience.

     

    Proven track record of leadership in clinical field with detailed understanding of health plan carrier and delivery systems.

     

    Demonstrated competency working with hospitals, provider groups, or integrated delivery systems to reduce healthcare costs and improve outcomes through both understanding detailed utilization and reporting and developing solutions to address costs

     

    Comprehensive understanding of population health and healthcare transformation and the solutions that exist in the market.

     

    Consultative skill set to work with customers, providers and internal teams to develop short term and long term clinical strategies.

     

    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 as well as third party solutions.

     

    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.

     

    Comprehensive understanding of carrier clinical programs and supporting national accounts is preferred.

    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 100 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.

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