The hiring range for this role is:
$224,000.00 - $271,000.00
This is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the hiring range and this hiring range may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs. This job is also eligible for annual bonus incentive pay.
We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.
Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
Job Description Summary:
Responsible to BCBS Plan and other key stakeholders to provide clinical expertise and leadership for medical affairs strategy development and implementation. Serves as a thought and opinion leader to provide clinical leadership and support to internal and external strategic initiatives in support of BCBSA and BCBS Plans. Works collaboratively with other medical directors to provide consultative leaders to the development of evidence-based reference medical policy information. Designs and implements innovative solutions that enable BCBS Plans to be proactive and that also enable industry leadership.
Responsibilities include but are not limited to:
- Medical Affairs Leadership-Responsible to BCBS Plan and other key stakeholders to provide clinical expertise and leadership for medical affairs strategy development and implementation. Serves as a thought and opinion leader to provide clinical leadership and support to internal and external strategic initiatives in support of BCBSA and BCBS Plans. Provides clinical guidance and support to initiatives that address public health issues. Implements deliverables in support of BCBSA Board strategies and OCA key initiatives
- Reference Medical Consultation-Collaborates with other medical directors to provide consultative leader and direction to Medical Policy Service in the development of evidence-based reference medical policy information.
- Communication Management-Publication: Manage and undertake process improvement for the internal communication on timelines, evidentiary review, and deliverables. BCBSA Board Strategies: deliver the identified content in support of the BCBSA Board Strategies, including precision medicine and medical policy management
- Ensure strong Thought Leader (TL) relationships; develop and nurture relationships with Key Opinion Leaders (KOLs) and consultants in the clinical community in order to strengthen BCBSA’s leadership position; serve as a professional representative of OCA in the healthcare community. Share responsibility with Clinical Operations for decisions regarding the recruitment and retention of pharmaceutical, medical device, as well as new business opportunities and strategies for product/platform development.
Required Education, Certifications and Experience:
Education
Certifications
- Medical license
- Board certification
Experience
- A minimum of 5 years health plan experience, as Medical Director or Medical Consultant with responsibility
- Experience in representing Medical Affairs and Clinical Operations to consumers, businesses, providers and media
Skills
- Demonstrated knowledge and experience of interaction of clinical operations with other Plan functions including but not limited to medical management, medical policy, legal, marketing, media, government relations, provider contracting etc.
- Knowledge of medical policy implementation, claims operations and provider and account relations
- Works effectively in cross functional teams
- Works effectively with Plan Medical Directors
- M.P.H. or other advanced degree is desired
- Written communication and presentation skills
People Management
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