Senior Medical Director, Regional Medical Director Network job San Francisco Cal
Senior Medical Director, Regional Medical Director Network job San Francisco Cal
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Senior Medical Director, Regional Medical Director Network Job

Employer Name: SpiderID: 13248539
Location: San Francisco, California Date Posted: 2/21/2023
Wage: Negotiable Category: Insurance
Job Code: 170023E-2191

Job Description:
Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California is focused on transforming health care by making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 3.5 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution.

We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone.


The Senior Medical Director, Regional Medical Director Network is accountable for utilization and quality performance across product lines; the primary focus is on the HMO and Medicare population (i.e. delegated delivery system partners). The role requires strong partnerships with other members of the Healthcare Quality and Affordability (HCQA) team and the Network Management team. In addition, the work can only be successful in close collaboration with the delivery system partners. As such, the Senior Medical Director will need to have strong insights and experiences in both health plan and delivery system work.

The Senior Medical Director will think strategically, have strong leadership and management skills, and be distinguished for the ability to get things done and achieve results. The ideal candidate will have a successful track record in clinical decision-making, health care plan knowledge, firsthand experience implementing clinical programs into delivery systems, and facility working with IPA's, medical groups, and hospital organizations.

The Senior Medical Director will manage a team of Regional Medical Directors, program managers, and supporting staff. This position reports to the Vice President for Accountable Care Innovation and Clinical Transformation. Specific responsibilities include:

Engage Key Delivery System Partners
Proactively engages with key delivery system partners to influence care delivery and to remove barriers to efficient, high quality care for BSC members. These relationships include:

• Hospital leadership such as a Vice President for Medical Affairs, Chief of Medical Staff, Hospitalist group leader, Emergency Department director, or service line chairs to address areas of opportunity to reduce admissions and/or improve timeliness and success of discharges.
• IPA/Medical Group leadership including the Medical and UM Directors to address areas of outlier performance on key metrics such as hospital bed days and non-emergent ED utilization.
• Individual high volume providers who manage BSC members by providing feedback on issues such as discretionary use of services, quality metrics and performance, and hospital utilization.
• These discussions shall be informed by data and lead to agreed upon actions that will be tracked and completed.

Work with Internal Blue Shield of CA (BSC) partners
• Provide clinical input to medical management leadership to assist in the evolution of medical management strategy and best practice development. This includes the ultimate integration of traditional UM strategies and Accountable Care Organization (ACO) methods of influencing practice patterns via a partnership model into a single approach.
• Partner with network contracting and participate in BSC meetings that design and implement Value Based Pay for Performance and other incentive plans to ensure consistency of messaging and optimization of behavior change in the delivery system.
• As part of the Regional Market Teams for Blue Shield of CA, partner with BSC HCQA teammates, including teams in utilization management, Medical Director concurrent review, ACO support, BSC Pharmacy and clinical quality improvement, among others.
• When needed, help resolve issues from BSC providers regarding case and disease management programs.

Implement Region-specific Strategy
• Lead the creation of a region-specific strategy and plan to achieve utilization and quality goals/targets.
• Develop a synchronized plan with the Network Management plan for business relationships with providers.
• The plan will use evidence based strategies for enhancing performance in Utilization and Clinical Quality.
• Responsible for monitoring the region-specific plan to ensure that the plan is executed as intended and to periodically make adjustments to the plan as necessary, in order to achieve affordability, clinical quality, and member experience targets.

Manage the Regional Medical Director Team
• Oversee, train, and hold accountable a team of Regional Medical Directors and program managers to assist in carrying out the vision described above. Currently this team includes seven physicians, three program managers and additional support staff.

Key leadership competencies:
Clinical Credibility
Interpersonal Excellence
Organizational Behavior Skills
Drive for Results
Written and Spoken Communication
Change Management
Team Collaboration
Relationship & Trust Building
Customer Focus
Financial/Quantitative Acumen
Seasoned Critical Thinking


• Active, unencumbered CA license (MD or DO)
• 5 years managed care experience
• Minimum 5 years leading and managing people

• Prior health plan experience - specifically as a Regional Medical Director
• IPA/Medical Group experience with >100,000 enrollees, including roles to influence practice change and to implement clinical interventions
• Clinical work in Internal Medicine, Family Practice, Pediatrics or emergency Medicine
• Understanding of the California marketplace, including the delegated model
• Understanding of Accountable Care Organizations, and experience working in them

Job Criteria:
Start Date:
Position Type: Full-Time Permanent
Years of Experience Required:
Education Required:
Overnight Travel:
Vacation Time:

Contact Information:
Contact Name: Blue Shield of California Company Type:
Company: Blue Shield of California

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