[Remote] Med Dir., Prov Perf & Clin Transf

Note: The job is a remote job and is open to candidates in USA. Horizon Blue Cross Blue Shield of New Jersey empowers members to achieve their best health and is seeking a Medical Director for Provider Performance and Clinical Transformation. This role involves designing and delivering provider education initiatives to enhance patient and provider experiences, improve population health, and promote value-based care.ResponsibilitiesDesign curriculum for provider education including but not limited to value based clinical workflows, utilization reduction strategies, quality, member experience, health equity and disparities, and appropriate risk adjustment/ codingDevelop provider education materials and approaches for providers at varying levels of readiness to transform:Collaborate with internal and external SMEs (e.g. other medical Directors, quality and risk adjustment teams, and others) to receive relevant materials, insights, and strategies to be incorporatedPartner with SIG and their many work-streams to ensure learnings and strategy are incorporatedResearch and incorporate global, national, and state based leading evidence based practicesUse output of Voice of Provider surveys and Population health surveys to inform this workCreate provider transformation evaluation process for benchmark and interval evaluationIdentify and refine key KPIs, in collaboration with enterprise partners, to incorporate into partner facing initiatives that will drive change in our VBP and FFS partner portfolioResearch forward-thinking transformation practice models and programs for incorporation into partner playbooks to improve performancePartner with network facilities and providers to develop and implement initiatives that drive quality, manage cost and improve performanceEstablish multidisciplinary teams for partner transformation engagement, for example, with transformation coach interactions, clinical collaboration calls, special KPI projects, etcServe as physician SME for projects related to transformation and Health Care Value across the enterprise, such as Clinical Performance Measurement & Predictive Analytics, Strategic Initiatives Group, Medical Economics and Risk Adjustment, etcDesign, update, implement, and review biannual value-based partner population health surveysTrain value-based team on the interpretation of clinical insights reports and the message delivery to partnersResearch, design, update, and implement value based quality program for each program yearSkillsRequires an Medical Doctor (MD) or Doctor of Osteopathy (DO) degreeRequires a minimum of 10 years clinical experience in patient centric/value based setting, NCQA certification preferredRequires a minimum of 5 years of medical management experience in a managed care settingRequires physician leadership experience in integrated delivery systems with financial accountabilityRequires experience with management of physicians and non-physiciansCurrent unrestricted Medical Doctor (MD) or Doctor of Osteopathy (DO) license from the state of New JerseyPrinciples of population health and value based carePrinciples of Utilization Management, URAC, NCQA UM Standards, and peer reviewState and federal regulations i.e. DOBI, DMAHS, CMSPrinciples and concepts of managed care and various models of health care delivery systemsPrinciples and concepts of managed care operations, policies, and reimbursementBusiness of medical practice managementBroad clinical knowledge and understanding of current health care issuesStrong clinical acumen to support understanding broad physical health issues, behavioral health issues, and social determinants of healthMedical literature analysisInterpretation and application of medical policy to provide guidance to othersExcellent verbal, written, and presentation skillsExpertise in the delivery of highly technical information to a general audiencePersonal computer, applicable softwareVirtual communication platformsBalance clinical issues with business imperatives and directives in the context of social responsibilityEvaluate data from various sources to identify trends and issuesDemonstrate professional and ethical business practices, adherence to company standards, and a commitment to personal and professional developmentManage multiple priorities, deliver timely and accurate work products with a customer service focusAbility to exercise sound judgment with strong problem solving skillsManage physicians and employee staffBuild alliances with provider community and have insight into the mindset of practicing physicians in NJFoster internal cross organizational collaborations to support project design and deliveryBenefitsComprehensive health benefits (Medical/Dental/Vision)Retirement PlansGenerous PTOIncentive PlansWellness ProgramsPaid Volunteer Time OffTuition ReimbursementCompany OverviewHorizon Blue Cross Blue Shield of New Jersey is a company that provides health insurance products. It was founded in 1932, and is headquartered in Newark, New Jersey, USA, with a workforce of 5001-10000 employees. Its website is http://www.horizonblue.com.